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