Inhalant-induced anxiety disorder

DSM-IV-TR (American Psychiatric Association 2000) recognizes inhalant-, anesthetic-, and solvent-related disorders (Table 13-8). Anesthetics are associated with substance-induced anxiety disorder. Inhalant-related disorders include intoxication, delirium, persisting dementia, psychotic disorders with delusions or hallucinations, mood or anxiety disorders, and disorders not otherwise specified. Diagnosis depends on history or laboratory studies described earlier in this chapter. Physical signs such as deposits from inhalants around the mouth or nose or on hands and clothing may indicate recent use (Westermeyer 1987). Nasal membranes may be inflamed (Wester-meyer 1987). 

Inhalant intoxication Inhalant intoxication delirium8 Inhalant-induced persisting dementia8 Inhalant-induced psychotic disorder,8 with delusions Inhalant-induced psychotic disorder, with hallucinations Inhalant-induced mood disorder Inhalant-induced anxiety disorder ... 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Inhalant-Induced Mood Disorder and Inhalant-Indueed Anxiety Disorder... 

Most inhalants or volatile substances are solvents, but the DSM-IV-TR text attributes only five of the eight disorders associated with inhalants to solvents substance-induced psychotic disorder, anxiety disorder, delirium, persisting amnestic disorder, and symptoms of dementia. The association of solvents with dementia is more controversial than their association with mood disorders, but DSM-IV-TR does not recognize mood disorder resulting from solvent exposure. These inconsistencies probably reflect incomplete fidelity between the literature and the psychiatric nosology rather than current opinion. 

Anxiety reactivity to 35% CO2 inhalations has been reported not to be significantly influenced by clinical characteristics of the disorder such as baseline anxiety, frequency of panic attacks, severity of agoraphobia, duration of illness, and age (Perna et al. 1994). On the other hand, several studies suggest a relevant role of genetic factors in 35% CO2-induced panic attacks, and it has been concluded that C02-induced panic might be considered a phenotypic expression of a genetic vulnerability to panic disorder even before the clinical onset of panic disorder (e.g., Perna et al. 1995 Bellodi et al. 1999). 

I Increased sensitivity to inhaled CO2 in panic disorder leading to panic anxiety (but paradoxically voluntary hyperventilation, causing hypocapnia, can also induce panic). I Lactate infusion (possibly by altering acid-base balance) provokes panic in attxious patients but not in controls. 

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