Anxiety disorders group

The clinical features, management, and prognosis of psychiatric symptoms in patients with chronic hepatitis C have been reviewed using data from 943 patients treated with interferon alfa (85%) or interferon beta (15%) for 24 weeks (333). Interferon-induced psychiatric symptoms were identified in 40 patients (4.2%) of those referred for psychiatric examination. They were classified in three groups according to the clinical profile 13 cases of generalized anxiety disorder (group A), 21 cases of... 

Rates of smoking among patients with bipolar disorders and anxiety disorders (e.g., posttraumatic stress disorder, panic disorder) are also higher than those in the general population (Lasser et al. 2000), but there has been htde smdy of the factors associated with motivation to quit smoking or of smoking cessation interventions in these patient groups. 

An Australian study compared medical utilization and costs in patients with panic disorder, those with social anxiety disorder, and a control group (Rees et al, 1998). Almost half of the panic disorder patients had seen a primary-care physician more than seven times over a 6-month period, compared with 7% of the social phobic patients and none of the control group. The mean costs were A 150, A 60 and A 20 respectively. The patients with panic disorder were treated with antidepressants (39%), benzodiazepines (15%), relaxants (12%), beta-blockers (7%) and other medication (7%). Twenty per cent received no medication. Patients with panic... 

The anxiety disorders are common and surprisingly disabling conditions. Studies on the health economics of generalized anxiety disorder, panic disorder, social anxiety disorders and obsessive compulsive disorder document the cost to the individual and to society. Attention has focused on the major psychiatric disorders such as depression, schizophrenia and the dementias. Studies suggest that many anxiety disorders are of early onset and too often chronic they are quite common and impose a heavy burden on society. More studies will be needed to discern the fine grain in the survey material and to identify more precisely the location and type of societal costs. These factors will vary from country to country, from district to district, between men and women and between various age groups. 

Ballenger JC, Davidson JRT, Lecrubier Y> et al (1998). Consensus statement on Social Anxiety Disorder from the International Consensus Group on Depression and Anxiety. / Clin Psychiatry 59 (suppl. 17)> 54-60. 

Ballanger JC, Davidson JR, Lecrubier Y, et al. Consensus statement on generalized anxiety disorder from the international consensus group on depression and anxiety. J Clin Psychiatry 2001 62(suppl 11) 53—58. 

A pooled analysis of 14 875 adults (Hispanic, n = 361 White, n = 10 108 African American, n = 547 Asian, n = 112) who participated in 104 double-blind, placebo-controlled paroxetine trials for mood and anxiety disorders was performed to ascertain minority group differences (Roy-Byrne et al., 2005). There were significant differences in rates of response by ethnicity (p = 0.014) with the odds of responding being lower for the Asian and Hispanic subjects compared to the African American and White subjects. There was also a higher placebo response rate in Hispanic subjects. Rapidity of response and emergence of adverse effects were similar across groups. 

How can good pharmacotherapists be found First, check with experienced and respected colleagues, take note of which pharmacotherapists are referring patients to you, attend local educational meetings with psychiatrists, or, if there is a medical school nearby, attend the psychiatry department s grand rounds. Local patient advocacy and support groups, such as the Depression and Bipolar Support Alliance (DBSA), the National Alliance for the Mentally HI (NAMI), the American Foundation for Suicide Prevention (AFSP), and the Anxiety Disorders Association of America (ADAA), are valuable sources of information from the patient s perspective. 

Taken together, the efficacy of antidepressants covers the spectrum of anxiety disorders, although there are important differences between drugs in the group (Table 3). Several new antidepressants have been marketed since the SS-RIs venlafaxine and mirtazapine are discussed later (Sects. 3.2.1.2 and 3.2.1.4) nefazodone, a serotonin reuptake inhibitor and postsynaptic 5-HT2 blocker showed promise in early studies but was recently withdrawn by its manufacturers reboxetine, a noradrenaline reuptake inhibitor (NARI) showed benefits in panic disorder in one published study (Versiani et al. 2002) and further evidence of its anxiolytic efficacy is awaited. 

This group includes compounds with actions on a range of neurotransmitter systems. Their antidepressant efficacy is mediated by reuptake inhibition of serotonin and noradrenaline, although side-effects such as sedation may also be useful. Their use in anxiety disorders is supported by a long history of clinical experience and a reasonable evidence base from controlled trials. Studies support the use of clomipramine (a potent serotonin reuptake inhibitor) in panic disorder and OCD (Lecrubier et al. 1997 Clomipramine Collaborative Study Group 1991), of imipramine in panic disorder and GAD (Cross-National Collaborative Panic Study 1992 Rickels et al. 1993), and of amitriptyline in PTSD (Davidson et al. 1993a). No controlled studies support the use of TCAs in social anxiety disorder. 

L.A., Hoven, C.W., Martinez, J., Kovalenko, P., Mandell, D.J., Moreau, D., Klein, D.F., and Gorman, J.M. (2000) Differential carbon dioxide sensitivity in childhood anxiety disorders and nonill comparison group. Arch Gen Psychiatry 57 960-967. 

Research Unit on Pediatric Psychopharmacology (RUH) Anxiety Study Group (2001) Flovoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 344 1279-1285. 

Comorbid anxiety has been associated with differential treatment response. This association predicts at times a better response to CBT and TCAs (Hughes et ah, 1990 Brent et ah, 1998). Treatment of comorbid anxiety, which most often precedes depression, is essential because the treatment contributes to improvement and may prevent future depressive episodes (Ko-vacs et ah, 1989 Hayward et ah, 2000). Fortunately, pharmacotherapy and psychotherapy treatments found useful for the treatment of MDD have also been found to be beneficial for treatment of youths with anxiety disorders (Kendall, 1994 RUPP Anxiety Group, 2001). 

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