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Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 35 Management of Anxiety Disorders
2Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Anxiety An uncomfortable state with psychologic and physical components Characterized by fear, apprehension, dread, and uneasiness Among the most common psychiatric illnesses
3Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Types of Anxiety Disorders Generalized anxiety disorder Panic disorder Obsessive-compulsive disorder (OCD) Social anxiety disorder (social phobia) Post-traumatic stress disorder (PTSD)
4Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Generalized Anxiety Disorder Characteristics Uncontrollable worrying that lasts 6 months or longer Not situational anxiety Treatment Nondrug approaches Supportive therapy Supportive therapy Cognitive behavioral therapy Cognitive behavioral therapy Biofeedback Biofeedback Relaxation training Relaxation training
5Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Generalized Anxiety Disorder Drug therapy Benzodiazepines Buspirone (BuSpar) Non-CNS depressant Non-CNS depressant Does not cause sedation Does not cause sedation Has no abuse potential Has no abuse potential Does not intensify the effects of CNS depressants Does not intensify the effects of CNS depressants Anxiolytic effects develop slowly Anxiolytic effects develop slowly Pharmacokinetics Pharmacokinetics Well absorbed following oral administration
6Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Generalized Anxiety Disorder Buspirone (BuSpar) (cont’d) Adverse effects Dizziness Dizziness Nausea Nausea Headache Headache Nervousness Nervousness Lightheadedness Lightheadedness Excitement Excitement
7Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Generalized Anxiety Disorder Buspirone (BuSpar) (cont’d) Drug and food interactions Erythromycin and ketoconazole Erythromycin and ketoconazole Grapefruit juice Grapefruit juice Tolerance, dependence, and abuse No withdrawal symptoms have been observed No withdrawal symptoms have been observed Preparations, dosage, and administration
8Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Generalized Anxiety Disorder Antidepressants Venlafaxine (Effexor XR) Paroxetine (Paxil) Short- and long-term Short- and long-term Escitalopram (Lexapro)
9Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. 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
10Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Panic Disorder Treatment Cognitive behavioral therapy (CBT) Drug therapy Antidepressants Antidepressants Selective serotonin reuptake inhibitors Tricyclic antidepressants Monoamine oxidase inhibitors Benzodiazepines Benzodiazepines First-line drugs for panic disorder
11Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Obsessive-Compulsive Disorder Characteristics Potentially disabling condition Persistent obsessions and compulsions Treatment Behavioral therapy Drug therapy Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs)
12Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Obsessive-Compulsive Disorder SSRIs First-line drugs for OCD Citalopram Citalopram Escitalopram Escitalopram Fluoxetine Fluoxetine Fluvoxamine Fluvoxamine Paroxetine Paroxetine Sertraline Sertraline Clomipramine (Anafranil) Less tolerated Less tolerated Second-line drug Second-line drug
13Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Social Anxiety Disorder (Social Phobia) Characteristics Intense, irrational fear that one might be scrutinized by others Generalized Generalized Nongeneralized Nongeneralized Very debilitating One of the most common psychiatric disorders Treatment Psychotherapy Drug therapy
14Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Post-Traumatic Stress Disorder Characteristics Develops following a traumatic event Re-experiencing the event Re-experiencing the event Avoiding reminders of the event Avoiding reminders of the event Persistent state of hyperarousal Persistent state of hyperarousal Treatment Psychotherapy with drugs Psychotherapy alone
Chapter 13 PANIC DISORDER. Panic Disorder An acute intense attack of anxiety accompanied by feelings of impending doom is known as panic disorder. The.
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