Anxiety disorders antipsychotic drugs

El-Khayat R, Baldwin DS (1998) Antipsychotic drugs for non-psychotic patients assessment of the benefit/risk ratio in generalized anxiety disorder. J Psychopharmacol 12 323-329 Elman MJ, Sugar J, Fiscella R, Deutsch TA, Noth J, Nyberg M, Packo K, Anderson RJ (1998) The effect of propranolol versus placebo on resident surgical performance. Trans Am... 

Furthermore, clinical trials are performed in various cultural and geographical settings. Transcultural differences may play a significant role in drug efficacy e.g. oriental populations require much lower doses of antipsychotic drugs compared with Caucasian patient populations. Phase IV trials also may be performed to explore possible novel uses for compounds approved and marketed in other indications (e.g. treatment of anxiety disorders with antidepressants, treatment of bipolar disorder with anticonvulsants, etc.). 

These drugs are the only effective treatment for schizophrenia, and are also used for the treatment of other psychoses. Low-dose antipsychotics are also frequently prescribed in the management of anxiety disorders. 

Other indications for the use of antipsychotics include Tourette s syndrome, disturbed behavior in patients with Alzheimer s disease, and, with antidepressants, psychotic depression. Antipsychotics are not indicated for the treatment of various withdrawal syndromes, eg, opioid withdrawal. In small doses, antipsychotic drugs have been promoted (wrongly) for the relief of anxiety associated with minor emotional disorders. The antianxiety sedatives (see Chapter 22) are preferred in terms of both safety and acceptability to patients. 

Hallucinogen persisting perception disorder is commonly called the flashback. While flashbacks are brief, usually lasting only a few seconds, these experiences often cause considerable anxiety and distress, due to the sudden, unanticipated onset of the episodes and the inability of the sufferer to control their occurrence. Psychotherapy is often sufficient treatment for anxiety and distress associated with flashbacks. Occasionally treatment with a long-acting tranquilizer, such as clonazepam, may be required. Anticonvulsant drugs, such as valproic acid and carbamazepine, have also been used to control flashbacks. However, antipsychotic drugs have been reported to exacerbate flashbacks and should not be prescribed. 

Propranolol also is used to treat various arrhythmias (Chapter 34), myocardial infarction (Chapter 31), congestive heart failure (Chapter 33), pheochromocytoma, and migraine (prophy-lactically). Propranolol also has been used for several off-label indications including parkinsonian tremors (sustained-release only), akathisia induced by antipsychotic drugs, variceal bleeding in portal hypertension, and generalized anxiety disorder. 

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