Anxiety disorders definition

The definition of desired therapeutic and side effects in the case of the benzodiazepines very much depends on the clinical problem in question. The sedative and hypnotic actions are desired effects in the treatment of insomnia, but undesired effects in the treatment of anxiety disorders. Effects that are usually undesired include daytime drowsiness, potentiation of the sedative effects of ethanol, and anterograde amnesia. They are mediated via the benzodiazepine site of GABAa receptors, since they can be antagonized with flumazenil. 

The anxiety disorders are a case in point. They comprise a range of conditions contiguous with the affective disorders and the stress responses (Table 4.1). Much overlap and comorbidity exist. Furthermore, definitions and diagnostic criteria have changed substantially over the years. For example, generalized anxiety disorder is a rare condition in its pure form, but a common condition if comorbid phobic and depressive disorders are accepted. 

Normal Introversion. As previously noted, normal shyness exists on a severity continuum with social anxiety disorder. The social anxiety experienced by normal introverts is transient and does not lead to avoidance of important social interactions or having to endure such encounters with tremendous discomfort though some degree of discomfort is often present. Among those with social anxiety disorder, these symptoms are more severe and/or persistent, and they by definition interfere with social or occupation functioning. 

Buspirone. A nonbenzodiazepine anxiolytic, buspirone is an effective treatment for generalized anxiety disorder but not other anxiety disorders. There are as yet no published controlled studies of buspirone for PTSD, though a small open label series suggested it might be effective for the core symptoms of PTSD. In the absence of more definitive evidence regarding its effectiveness, we do not routinely use buspirone when treating PTSD. 

Another issue is that many primary care physicians have difficulty distinguishing between depressive and anxiety disorders. This has led to the impression that patients in a general medical setting are more likely to have an admixture of symptoms, rather than a clearly defined condition. That depressed patients have anxiety symptoms and anxiety-disordered patients have depressive symptoms, as assessed by the Flamilton scales, are used to support this clinical impression, which ignores the fact that these scales were developed to quantitate symptoms only after a definitive syndromic diagnosis had been made. 

Post traumatic stress disorder (PTSD) is the only psychiatric condition whose definition demands a particular stressor to precede its appearance. Unlike the other anxiety disorders, it is only in the past decade that the biology of PTSD has come under scrutiny. Furthermore, although PTSD can occur following various traumatic events (for example, sexual abuse, accidents and torture), most emphasis has been placed on combat-related disorders. 

Dosing varies considerably among individual patients but is definitely at the lower end of the dosing spectrum for patients with chronic neuropathic pain or anxiety disorders (i.e., 2-12 mg either as a split dose or all at night)... 

Lack of definitive evidence of efficacy for chronic neuropathic pain or anxiety disorders suggests risk/benefit ratio is in favor of discontinuing tiagabine during pregnancy for those indications... 

Obsessive-compulsive disorder (OCD) is a syndrome characterized by obsessions and/ or compulsions, which together last at least an hour per day and are sufficiently bothersome that they interfere with one s normal social or occupational functioning. Obsessions are experienced internally and subjectively by the patient as thoughts, impulses, or images. According to standard definitions in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), obsessions are intrusive and inappropriate and cause marked anxiety and distress. Common obsessions are listed in Table 9—1. 

Alterations in 5-hydroxytryptamine (5-HT) neurotransmission have been implicated in a number of human disorders such as migraine, depression and anxiety as well as in normal human functions such as sleep, sexual activity and appetite. Unfortunately, the scientific association between 5-HT and these disorders has been largely suggestive rather than definitive. Nonetheless, recent advances in the understanding of 5-HT receptor subtypes have strengthened the ability to document specific links between modulation of 5-HT neurotransmission and human disease states. This brief chapter will present an overview of the current status of 5-HT receptor subtypes. 

Based on these criteria, it is clear that people with antisocial personality disorder would be unpleasant to deal with and might be frightening. It should also be pointed out that mental disorders such as depression and anxiety can often be of relatively short duration (6 months to several years). In contrast, a personality disorder is, by definition, an enduring pattern of behavior that has been present since adolescence or early adulthood and rarely, if ever, changes. 

Debate about the association between SSRIs and suicidality, particularly in children and adolescents, continues. A metaanalysis of 57 placebo-controlled trials of paroxetine involving 14911 patients with anxiety and depressive disorders showed no significant differences between paroxetine and placebo in rates of definitive... 

The field of psychiatry is predicated on the assumpt-tion that serious mental disorders result from abnormalities in the structure or function of the brain. Although no specific brain anomalies have been identified as the definitive cause of mental illness, the latest neuroscientific studies suggest that imbalances in neurochemicals—also called neurotransmitters— or malfunctions in their transportation from nerve cell to nerve cell might be responsible for the symptoms of mental illness, such as anxiety, depression, hallucinations, and delusions. Neurotransmitters include dopamine, norepinephrine, serotonin, and gamma-amino-butyric acid. Most experts believe that the causes of mental illness stem from a combination of genes (nature) and experiences (nurture). 

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