Anxiety disorders Obsessive-compulsive disorder Posttraumatic

Data from Katon WJ. Panic disorder. N Engl J Med 2006 354 2360-2367 Bandelow B, Zohar J, Hollander E, etal. Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 2002,3 171-199 Work Group on Panic Disorder. Practice guideline for the treatment of patients with panic disorder. Am J Psychiatry 1998 155(Supp 5) l-34 and EffexorXR[package insert]. Philadelphia, PA Wyeth Pharmaceuticals, Inc., August 2006. 

Bandelow B, Zohar J, Hollander E, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry. 2002 3 171-199. 

Sertraline hydrochloride is used in the management of depression, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and social anxiety disorder. 

GAD, generalized anxiety disorder PD, panic disorder OCD, obsessive-compulsive disorder SAD, social anxiety disorder PTSD, posttraumatic stress disorder. Also indicated as an anticonvulsant. 

Antidepressants tend to provide a more sustained and continuous improvement of the symptoms of attention-deficit/hyperactivity disorder than do the stimulants and do not induce tics or other abnormal movements sometimes associated with stimulants. Indeed, desipramine and nortriptyhne may effectively treat tic disorders, either in association with the use of stimulants or in patients with both attention deficit disorder and Tourette s syndrome. Antidepressants also are leading choices in the treatment of severe anxiety disorders, including panic disorder with agoraphobia, generalized anxiety disorder, social phobia, and obsessive-compulsive disorder, as weU as for the common comorbidity of anxiety in depressive illness. Antidepressants, especially SSRIs, also are employed in the management of posttraumatic stress disorder, which is marked by anxiety, startle, painful recollection of the traumatic events, and disturbed sleep. Initially, anxious patients often tolerate nonsedating antidepressants poorly (Table 17-1), requiring slowly increased doses. Their beneficial actions typically are delayed for several weeks in anxiety disorders, just as they are in major depression. 

The nosology of anxiety disorders has changed considerably over the past 40 years (141). Such disorders were not mentioned in the original DSM. In DSM-II, problems with anxiety were considered a subset of behavioral disorders and were restricted to overanxious and withdrawing reactions. The DSM-III defined three types of anxiety disorders in children and adolescents overanxious, avoidant, and separation disorder. The DSM-III also acknowledged that children and adolescents could meet adult criteria for simple phobias, panic disorder, posttraumatic stress disorder, and obsessive-compulsive disorder (OCD). In DSM-IV ( 45), generalized anxiety disorder (GAD) and social phobia (or social anxiety disorder with childhood onset) replaced overanxious disorder and avoidant disorder, respectively. 

By the 1990s antidepressants from the serotonin selective reuptake inhibitor (SSRI) class became recognized as preferred first-line treatments for anxiety disorder subtypes, ranging from obsessive-compulsive disorder, to panic disorder, and now to social phobia and posttraumatic stress disorder (Fig. 8—9). Not all antidepressants, however, are afficacious anxiolytics. For example, desipramine and bupropion seem to be of little help in several anxiety disorder subtypes. Documentation of efficacy... 

In this chapter we have given clinical descriptions and have also explored the biological basis and a variety of treatments for numerous anxiety disorder subtypes, including obsessive-compulsive disorder, panic disorder, social phobia, and posttraumatic stress disorder. 

Although neuroticism is not a disease per se, it predisposes individuals to anxiety disorders (12, 13). Neuroticism is a vulnerability factor for all forms of anxiety (14-16). A system established by the Diagnostic and Statistical Manual for Psychiatric Disorders in the United States, currently in its 4th edition (DSM-IV) text revision (TR) (American Psychiatric Association, 2000), sets the boundary at which a particular level of behavior becomes an anxiety disorder—a level often based on the number and the duration of symptoms. DSM is a categorical system based on the qualitative separation of disease states from the state of well-being. The DSM-IVTR category of anxiety disorders currently includes generalized anxiety disorder (GAD), simple phobia, posttraumatic stress disorder (PTSD), panic disorder, social phobia, and obsessive compulsive disorder (OCD) as discrete anxiety disorders. The International Classification of Diseases-10 (IC-10) is a similar system, but it is less frequently used in research (17). 

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. 

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision classifies anxiety disorders into several categories GAD, panic disorder (with or without agoraphobia), agoraphobia, SAD, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and acute stress disorder. The characteristic features of these illnesses are anxiety and avoidance behavior. 

Anxiety Disorders II Posttraumatic Stress Disorder and Obsessive-Compulsive Disorder... 

CHAPTER 70 ANXIETY DISORDERS II POSTTRAUMATIC STRESS DISORDER AND OBSESSIVE-COMPULSIVE DISORDER... 

Paroxetine is a selective serotonin reuptake inhibitor that blocks reuptake of serotonin, enhancing serotonergic function. It is used to treat panic disorder or social anxiety disorder (except Pexeva), as defined in the DSM-IV major depressive disorder, as defined in DSM-111 (immediate release) orDSM-lV (controlled release). Immediate release only for obsessive-compulsive disorder (OCD) generalized anxiety disorder (GAD) (except Pexeva) posttraumatic stress disorder (PTSD), as defined in the DSM-IV (except Pexeva). 

Psychiatrists prescribe antipsychotics to treat mental illnesses that cause patients to experience marked breaks with reality (psychosis). The most common of such disorders is schizophrenia, which is a chronic, disabling, persistent, and severe brain disease that sigpiificantly impairs brain functioning and affects 1 percent of the world s population, including 3 million people in the United States alone. Antipsychotic medications are referred to as typical or atypical. Psychiatrists prescribe anxiolytics (antianxiety medications) to treat anxiety disorders, which include panic disorder, generalized anxiety disorder, specific phobias, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder. Psychiatrists prescribe antidepressants and mood stabilizers to treat the symptoms of mood disorders, the most common and severe of which are major depression and bipolar disorder. 

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