Anxiety disorders insomnia

Benzodiazepines. The benzodiazepines were developed in the 1950s and introduced into the U.S. market in the 1960s. They have found a variety of uses including the treatment of several anxiety disorders, insomnia, seizure disorders, alcohol withdrawal, surgical anesthesia, and others. The benzodiazepines have also been used to calm agitated patients and are therefore useful during the acute treatment phase of bipolar mania. 

Once chronic insomnia has developed, it hardly ever spontaneously resolves without treatment or intervention. The toll of chronic insomnia can be very high and the frustration it produces may precipitate a clinical depression or an anxiety disorder. Insomnia is also associated with decreased productivity in the workplace and more frequent use of medical services. Einally, substance abuse problems may result from the inappropriate use of alcohol or sedatives to induce sleep or caffeine and other stimulants to maintain alertness during the day. 

Modulation of GABA receptors is also beneficial in the treatment of several neuropsychiatric conditions, including anxiety disorders, insomnia, and agitation. The mechanisms are not well understood but may work through a general inhibition of neuronal activity. Benzodiazepines and ethanol use the same mechanism to influence GABA receptors. This property is the basis for ethanol detoxification with benzodiazepines (Grobin et ah, 1998). 

Acute anxiety states panic attacks generalized anxiety disorder insomnia and other sleep disorders relaxation of skeletal muscle anesthesia (adjunctive) seizure disorders... 

Anxiety disorders and insomnia represent relatively common medical problems within the general population. These problems typically recur over a person s lifetime (3,4). Epidemiological studies in the United States indicate that the lifetime prevalence for significant anxiety disorders is about 15%. Anxiety disorders are serious medical problems affecting not only quaUty of life, but additionally may indirecdy result in considerable morbidity owing to association with depression, cardiovascular disease, suicidal behavior, and substance-related disorders. 

Pharmacological Profiles of Anxiolytics and Sedative—Hypnotics. Historically, chemotherapy of anxiety and sleep disorders rehed on a wide variety of natural products such as opiates, alcohol, cannabis, and kawa pyrones. Use of various bromides and chloral derivatives ia these medical iadications enjoyed considerable popularity early ia the twentieth century. Upon the discovery of barbiturates, numerous synthetic compounds rapidly became available for the treatment of anxiety and insomnia. As of this writing barbiturates are ia use primarily as iajectable general anesthetics (qv) and as antiepileptics. These agents have been largely replaced as treatment for anxiety and sleep disorders. 

Benzodiazepines, ie, the hiU BZR agonists, are prescribed for anxiety, insomnia, sedation, myorelaxation, and as anticonvulsants (97). Those benzodiazepines most commonly prescribed for the treatment of anxiety disorders are lorazepam (19), alprazolam (20), diazepam (21), bromazepam (22), chlorazepate (23), and oxazepam (24). These dmgs together represent about 70% of total... 

Benzodiazepines are amongst the most frequently prescribed drugs they have well-established uses in the treatment of anxiety disorders (anxiolytics) and insomnia, preanaesthetic sedation, suppression of seizures, and muscle relaxation. 

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. 

Older adults are especially sensitive to the effects of the CNS stimulants and may exhibit excessive anxiety, nervousness insomnia, and mental confusion. Cardiovascular disorders common in the older adult, maybe worsened by the CNS stimulants Careful monitoring is important because the presence of these reactions may result in the need to discontinue use of the drug. 

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Lejoyeux et al. 1998). Similar to opioid-dependent persons, these patients reported that they use benzodiazepines to self-medicate anxiety, insomnia, and alcohol withdrawal and, less commonly, to enhance the effects of ethanol. Approximately l6%-25% of patients presenting for treatment of anxiety disorders abuse alcohol (Kushner et al. 1990 Otto et al. 1992). Controversy exists concerning appropriate benzodiazepine prescribing in this population (Cir-aulo and Nace 2000 Posternak and Mueller 2001). 

Functioning in a compiex and dangerous environment requires one to possess effective mechanisms of arousai, both arousai to consciousness and emotionai arousai, in order to meet the demands on behavior. For exampie, an organism needs to be abie to arouse behavioraiiy in order to deai with predators and other environmentai threats. As is often the case with disorders of the mind and brain, normai and adaptive mechanisms can be overactivated and thus become maiadaptive. A common outcome of this overactivation is anxiety and insomnia. 

Lorazepam Ativan Oral, IV, IM Intermediate 1-10 Anxiety disorders, alcohol withdrawal, insomnia... 

Generalized Anxiety Disorder. The symptoms of GAD overlap with certain hyperarousal symptoms of PTSD, such as insomnia and poor concentration. The distinction between GAD and PTSD lies in the object of the worry. Patients with GAD worry about an array of everyday concerns, whereas those with PTSD specifically ruminate about the trauma and events related to the trauma. 

Barbiturates. The first barbiturate, barbital, was introduced at the turn of the 20th century. Hundreds of others, including phenobarbital and pentobarbital, were later developed. The barbiturates were a highly successful class of medications as it became clear that they treated not only alcohol withdrawal but seizure disorders, anxiety, and insomnia as well. By the 1960s, however, the barbiturates were largely surpassed by the benzodiazepines. The newer benzodiazepines act in a similar fashion and provide much the same therapeutic benefit but are significantly safer and easier to tolerate. 

Insomnia Due to Another Psychiatric Illness. Insomnia is often a symptom of mood and anxiety disorders. Depression is classically associated with early-morning awakening of the melancholic type, whereas so-called atypical depression leads to hypersomnia. Anxiety commonly leads to problems falling asleep. These patterns are not invariable. One should therefore always perform a thorough assessment for anxiety or depression in patients complaining of insomnia. 

The development of tolerance is a major drawback to the use of benzodiazepines in the long-term treatment of insomnia. Whereas tolerance to the hypnotic effects of benzodiazepines permits them to be used without excessive sedation when treating anxiety disorders, this is counterproductive when attempting to treat insomnia. Patients often find themselves requiring higher doses to obtain the same sedative-hypnotic effect initially accomplished by lower doses. For this reason, careful consideration must be given before benzodiazepines are used to treat chronic insomnia. 

In addition to treating insomnia, gabapentin has been used to treat epilepsy, anxiety disorders, and bipolar disorder. It is generally well tolerated with sedation and headaches being the only prominent side effects. Because gabapentin is excreted unchanged in urine, it does not require metabolism by the liver. It is therefore easily eliminated by elderly patients and those with liver disease, although it should be used with caution in those with poor renal (kidney) function. 

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