Anxiety comorbid alcohol abuse

Anxiety and dissociative symptoms (e.g., sense of numbing or absence of emotional responsiveness, derealization, depersonalization, inability to recall important features of the event) emerging within 1 month after exposure to a traumatic stressor are classified as ASD. Symptoms of ASD are experienced during or immediately after the trauma, last for at least 2 days, and resolve within 4 weeks. The age of onset and course of PTSD are variable. PTSD can occur at any age. The presentation is not predictable because symptoms are related to the duration and intensity of the trauma, the presence of other psychiatric disorders, and how the patient deals with the trauma. The average duration of symptoms in patients in treatment is about 36 months. In those not receiving treatment, symptoms can last for a mean of 5 years. About one-third of patients with PTSD have a poor prognosis for recovery. About 80% of patients with PTSD have a concurrent depression or anxiety disorder. Over half of men with PTSD suffer from comorbid alcohol abuse or dependence. About 20% of patients with PTSD attempt suicide. ... 

Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer prognosis. 

Children with PTSD may be more likely to have comorbid conditions because traumatic insults occur in developmentally sensitive periods. Early life trauma is particularly toxic in its effects on development. Adults with severe sexual abuse histories exhibit high rates of debilitating disorders such as depression, anxiety disorders, alcoholism, substance abuse, and personality disorders (Herman and Van der Kolk, 1987 Putnam and Trickett, 1993). 

Although depression is the most prominent comorbid illness, a variety of other psychiatric conditions may be associated with panic disorder, for example, agoraphobia [60% of patients with panic disorder], other anxiety disorders (20%), and drug and alcohol abuse [15%] [Klerman 1992). 

The major benefit of BZDs may be in diminishing some of the secondary symptoms of an acute exacerbation (e.g., insomnia, agitation, panic, and other general anxiety symptoms) that are not necessarily rapidly and specifically affected by lithium or antipsychotics. With this approach, exposure to antipsychotics may be precluded in some situations and kept to a minimum in others, thus avoiding the potential for more serious antipsychotic-induced adverse effects. Additionally, given the high comorbidity with alcohol abuse/dependence, concurrent withdrawal symptoms may also be managed with BZDs. 

Posttraumatic stress disorder (PTSD) is another anxiety disorder that can be characterized by attacks of anxiety or panic, but it is notably different from panic disorder or social phobia in that the initial anxiety or panic attack is in response to a real threat (being raped, for example) and subsequent attacks are usually linked to memories, thoughts, or flashbacks of the original trauma. The lifetime incidence of PTSD is about 1%. Patients have disturbed sleep and frequent sleep complaints. Comorbidities with other psychiatric disorders, especially depression and drug and alcohol abuse, are the rule rather than the exception. The DSM-IV diagnostic criteria are given in Table 9—11. 

Bipolar mixed episode (previously known as mixed state, dysphoric mania, or depressive mania) is defined as the simultaneous occurrence of manic and depressive symptoms. Mixed mood states occur in up to 40% of all episodes, and are more common in younger and older patients and in females. Mixed episodes are often difficult to diagnose and treat because of the fluctuating clinical presentation. Patients with mixed states often have comorbid alcohol and substance abuse, severe anxiety symptoms, a higher suicide rate, and a poorer... 

Patients with OCD often have comorbid depression, anxiety disorders, and alcohol abuse or dependence. It is a chronic illness in most patients, with severity of symptoms varying in intensity over time. Many patients with OCD have significantly impaired QOL and ability to function. ... 

It is considered a second-line agent for GAD because of inconsistent reports of efficacy, delayed onset of effect, and lack of efficacy for comorbid depressive and anxiety disorders (e.g., panic disorder or SAD). It is the agent of choice in patients who fail other anxiolytic therapies or in patients with a history of alcohol or substance abuse. It is not useful for situations requiring rapid antianxiety effects or as-needed therapy. 

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