Anxiety disorders continued

While some anecdotal evidence has suggested possible benefit from buspirone in children (Zwier and Rao, 1994), in the study by Pfeffer (1997), only 3 of the 19 children who completed the study continued on buspirone after the study. The benefits of buspirone in children with anxiety disorders continue to be unproven. However, open-label studies have demonstrated reductions in anxiety in children with pervasive developmental disorders (Buitelaar et al., 1998). 

For patients with severe PMDD with comorbid psychiatric disorders such as depressive or anxiety disorder, continuous dosing (daily dose) is recommended the SSRIs fiuoxetine at a dose of 20 mg/day or sertraiine at a dose of 25-50 mg ay are considered first-line treatment (the doses are somewhat lower than those used in other... 

The onset of response to antidepressants in social anxiety disorder is delayed and may be as long as 8 to 12 weeks. Patients responding to medication should be continued on treatment for at least 1 year. 

In contrast to the depression literature, there has been little discussion of the taxonic structure of anxiety disorders. Consequently, taxometricians have paid considerably less attention to anxiety, though a few studies have very recently been conducted in this area. In this literature, there is evidence favoring both categorical and continuous models, and we start by reviewing the nontaxonic findings. 

There has been little formal study of maintenance therapy for social anxiety disorder. Limited data indicates that continued pharmacotherapy provides significant prophylactic protection against relapse. Furthermore, growing evidence indicates that patients with social anxiety disorder experience a high rate of relapse after treatment discontinuation. CBT, however, may afford continued prophylactic benefit long after conclusion of the therapy, though the data to support this contention is limited. 

Antidepressants are only recommended in the rehabilitation and continuing care stages of treatment for alcohol and cocaine dependence if the patient has a comorbid depressive or anxiety disorder. 

Inattentiveness, impulsivity, hyperactivity 50% will continue to manifest the disorder into adulthood Stimulants (70% response for uncomplicated ADHD caution in patients with tic disorders) TCAs (70% response, first line for patients with comorbid MD or anxiety disorders, and for patients with ADHD + tics) requires serum levels and cardiovascular monitoring Bupropion Clonidine, guan-facine (first line for patients with ADHD + tics) MAOIs Combined pharmacotherapy for treatment-resistant cases... 

One continuing theme in the treatment of anxiety disorders is that there is a large amount of individual variability in the effectiveness of different treatments. Basically, this means that different things work for different people, and part of the challenge... 

Alternative Therapies for Anxiety Disorders 101 Table 6.1 (continued)... 

Research into the treatment of adolescent anxiety disorders is still in the early stages. Few studies have been conducted (compared with those regarding adults) on the effectiveness of anti-anxiety drugs in adolescents. However, as the use of these drugs continues to rise, the growing interest will continue to encourage further research into this area. 

Feighner and Cohen [1989) performed a pooled-data analysis of six studies of buspirone in the treatment of generalized anxiety disorder. Buspirone was observed to improve all symptom groups on the Hamilton Anxiety Scale [M. Hamilton 1959). Onset of anxiolytic therapy was evident within 1 week, whereas continued improvement was evident until the 4-week end point. The psychic symptoms of anxiety, such as anxious mood, tension, irritability,... 

To date, evidence suggests that cholecystokinin-B activation may trigger a cascade of neurochemical events culminating in both the psychic and the somatic features of anxiety. In summary, these data continue to suggest an interesting opportunity to qualitatively broaden the clinician s armamentarium against one or more of the anxiety disorders. 

Meanwhile, benzodiazepines became second-line treatments or augmentation treatments for these anxiety disorder subtypes in the 1990s. While buspirone continues to be recognized as a first-line general anxiolytic, it has not developed a convincing efficacy profile for anxiety disorder subtypes or for the treatment of major depressive disorder. 

Ecstasy has not been proven safe or effective for any medical use, and it is not available by prescription. In the 1970s, ecstasy was used as an aid in psychotherapy because the drug reportedly could intensify the patient s feelings of openness and intimacy in revealing deeply personal feelings however it was declared illegal a decade later. There continue to be supporters of ecstasy use in psychotherapy and for treatment of stress and anxiety disorders. 

In a multicenter, double-blind trial, abecarnil (mean daily dose 12 mg), diazepam (mean daily dose 22 mg), or placebo were given in divided doses for 6 weeks to 310 patients with generalized anxiety disorder (1). Those who had improved at 6 weeks could volunteer to continue double-blind treatment for a total of 24 weeks. Slightly more patients who took diazepam (77%) and placebo (75%) completed the 6-week study than those who took abecarnil (66%). The major adverse events during abecarnil therapy were similar to those of diazepam, namely drowsiness, dizziness, fatigue, and difficulty in... 

Continue treatment of depression and anxiety disorders until all symptoms are gone (remission)... 

---