Anxiety disorders obsessive-compulsive

Panic disorder Agoraphobia with panic disorder Agoraphobia without panic disorder Specific phobia Social phobia Generalised anxiety disorder Mild anxiety and depression disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD) Adjustment disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Specific phobia Social phobia (also called social anxiety disorder) Generalised anxiety disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD)... 

Anxiety disorders (e.g., generalized anxiety disorder, obsessive-compulsive disorder) Substance abuse (alcohol or sedative-hypnotic withdrawal)... 

Disorders that would formerly have been grouped under neuroses include depression in the absence of psychotic s)nnptoms, anxiety disorders (e.g. panic disorder, generalised anxiety disorder, obsessive-compulsive disorder, phobias and post-traumatic stress disorder), eating disorders (e.g. anorexia nervosa and bulimia nervosa) and sleep disorders. 

Adjustment reaction Phobic disorders Panic disorders Generalized anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder... 

The mood and anxiety disorders in their various permutations constitute a major source of personal suffering and impaired ability to engage in productive Avork and interpersonal relationships. Between 5 and 9% of women and between 2 and 3% of men meet the diagnostic criteria for major depression at any time 10-25% of all women suffer major depression sometime in their lives, while 5-10% of men will develop major depressive disorder (American Psychiatric Association, 1994). The anxiety disorders obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, and generalized anxiety disorder (GAD) show lifetime prevalence rates of approximately 2.5%, 7%, 2.5%, and 5% respectively. Between 3 and 13% of individuals in community samples are regarded to meet the diagnostic criteria for social phobia. Mood and anxiety disorders are common comorbidities (American Psychiatric Association, 1994) and the most common antidepressant medications including the serotonin reuptake inhibitors, the mixed serotonin-catecholamine reuptake inhibitors, the tricyclic antidepressants, and the monoamine oxidase inhibitors, are all effective treatments for anxiety and panic attacks. 

Treatment Guidelines for Schizophrenia, Major Depression, Bipolar Illness, Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Social Anxiety Disorder, American Pharmaceutical Association Publications Bethesda, Maryland, copyright 1998-2000. 

Freud coined the term anxiety neurosis approximately 100 years ago, and all forms of anxiety would be subsumed under that collective diagnostic entity for decades to come. In 1980, based on an emerging literature DSM-111 classified anxiety disorders into several discrete syndromes including panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). 

In this chapter, we consider categorical anxiety disorders as defined by the standardized diagnostic criteria of American Psychiatric Association s Diagnostic and Statistical Manual for Psychiatric Disorders [i.e., DSM-III (1980), DSM-III-R (1987), DSM-IV (1994)]. The subtypes of anxiety states included are panic disorder, agoraphobia, specific phobia, social phobia, generahzed anxiety/overanxious disorder, separation anxiety, and obsessive-compulsive disorder. 

Post, R.M. and Weiss, S.R. (1998) Sensitization and kindling phenomenon in mood, anxiety, and obsessive compulsive disorders the role of serotonergic mechanisms in illness progression. Biol Psychiatry 44 193—206. 

St. John s wort has been used to treat a wide range of ailments for more than 2000 years, and is said to have been prescribed by Hippocrates himself. Apart from depression, St. John s wort is being promoted or used as a treatment for attention-deficit hyperactivity disorder (ADHD), anxiety, stress, obsessive-compulsive disorder, sleep problems, nocturnal enuresis, bacterial and viral infections such as HIV-AIDS, respiratory conditions, peptic ulceration, inflammatory arthritis, cancer, and skin wounds (Rey and Walter, 1998 Walter et ah, 2000). It is also said to increase libido, an application dating from the Middle Ages (Fletcher, 1996). No empirical evidence is currently available to support any of these uses. 

The anxiolytic activity of several compounds in some, but not all, animal models of anxiety in fact suggests that different receptor subtypes may modulate different types of anxiety as discussed below. It would not be surprising if the specific serotonin links to disorders of anxiety also differ among the various disorders of anxiety such as generalized anxiety versus obsessive-compulsive disorder versus panic disorder versus social phobia versus mixed anxiety depression. Such studies are in progress, and much further research is necessary to clarify the potential links between subtypes of anxiety and subtypes of serotonin receptors. 

Paroxetine. Paroxetine, also a serotonin reuptake inhibitor, has been the subject of a case report in two subjects. Ringold [1994] reported the effective treatment of two individuals who had not responded to prior therapy with fluoxetine and sertraline. Both individuals had comorbid psychiatric problems. Subject A demonstrated both social phobia and dysthymia. Although her symptoms of dysthymia were clinically responsive to fluoxetine therapy, her social phobia symptoms were resistant. Subject B had body dysmorphic disorder, obsessive-compulsive disorder, and social phobia. His obsessive-compulsive disorder symptoms benefited from fluoxetine therapy, but his social anxiety was resistant. Sertraline therapy was attempted in both subjects. Subject A required discontinuation because of adverse effects. Subject B experienced a worsening of both obsessive-compulsive disorder and social phobia symptoms. Both subjects demonstrated a positive response in their symptoms when switched to paroxetine [20 mg/day]. 

Fluoxetine Highly selective blockade of serotonin transporter (SERT) little effect on norepinephrine transporter (NET) Acute increase of serotonergic synaptic activity slower changes in several signaling pathways and neurotrophic activity Major depression, anxiety disorders panic disorder obsessive-compulsive disorder post-traumatic stress disorder perimenopausal vasomotor symptoms eating disorder (bulimia) Half-lives from 15-75 h oral activity Toxicity Well tolerated but cause sexual dysfunction Interactions Some CYP inhibition (fluoxetine 2D6, 3A4 fluvoxamine 1A2 paroxetine 2D6)... 

Some mental disorders, such as schizophrenia or bipolar illness, may have a higher chance of being expressed in vulnerable individuals as compared with disorders such as depression, anxiety, or obsessive-compulsive disorder, which may more frequently lie dormant in the vulnerable individual (Fig. 4—5). Thus, genetic endowment gives... 

In addition to the treatment of depression, the Food and Drug Administration (FDA) has approved the (on-label) use of the antidepressants for treatment of panic disorders, obsessive-compulsive disorders, bulimia nervosa, social phobia, and generalized anxiety disorder. And although not the treatment of choice, the tricyclics are sometimes used for enuresis—bed wetting. 

Other psychiatric illnesses, particularly the anxiety disorder, are also risk factors for development of major depressive disorder. Persons with anxiety disorders (panic disorder, obsessive compulsive cUsorder, social phobia, generalized anxiety disorder, and posttrauma tic stress disorder) go on to develop major depressive cUsorder over the course of 5-20 years in over 50% of cases. 

Beyond these issues, it should be noted that antidepressant medications also are used in the treatment of anxiety disorders. Tricyclic antidepressants and SSRIs both have been used in the treatment of such anxiety disorders as panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. 

PMDD is not the only mental disorder that can be treated with SSRIs. There are many kinds of syndromes that SSRIs have been approved to treat. These syndromes include eating disorders, obsessive-compulsive disorder, post-traumatic stress disorder, panic disorder, and generalized anxiety disorder. Although each SSRI would probably be just as effective in treating these syndromes, the companies that own them have done extensive research to find a niche for their drug. Thus some SSRIs, such as Paxil (paroxetine), are approved for social phobia simply because the company that owns them has done the clinical studies proving it is effective and therefore should be licensed for it. Indeed, there seems to be no end to syndrome niche markets in which SSRIs can be effective. There are now efforts to market some SSRIs as treatments... 

The drug exerts its therapentie aetion to eombat various types of anxiety disorders viz., generalized anxiety disorders, panie attaeks, phobie disorders, obsessive-compulsive disorder, post-tranmatic stress disorder, and mixed anxiety and depressive disorders. Perhaps the drug acts as a atypical antisychotic agent by virtue of its reduced tendency to produce the extrapyramidal effects. 

The primary uses for the SSRIs include MMD and bipolar depression (fluoxetine, paroxetine, sertraline, and citalopram), atypical depression (i.e., depressed patients with unusual symptoms, e.g., hypersomnia, weight gain, and interpersonal rejection sensitivity fluoxetine, paroxetine, sertraline, and citalopram), anxiety disorders, panic disorder (sertraline and paroxetine), dysthymia, premenstrual syndrome, postpartum depression, dysphoria, bulimia nervosa (fluoxetine), obesity, borderline personality disorder, obsessive-compulsive disorder (fluvoxamine, fluoxetine, paroxetine, and sertraline), alcoholism, rheumatic pain, and migraine headache. Among the SSRIs, there are more similarities than differences however, the differences between the SSRIs could be clinically significant. 

Serotonin has been found to influence sleeping, the regulation of body temperature, and sensory perception, but its exact role in mental illness is not yet clear. Unusually low levels of 5-hydroxyindoleacetic acid, a product of serotonin utilization, are characteristically found in the spinal fluid of victims of violent suicide. Drugs that mimic serotonin are sometimes used to treat depression, anxiety, and obsessive-compulsive disorder. Serotonin blockers are used to treat migraine headaches and relieve the nausea that accompanies cancer chemotherapy. A better understanding of the biochemistry of the brain may lead to better medications for treating various forms of mental illness. 

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