Anxiety disorders other potential treatments

Both acute and chronic anxiety can be treated with benzodiazepines, although it is anticipated that for most anxiety disorders counseling will also play an important role. Benzodiazepines employed in the treatment of anxiety should be used in the lowest effective dose for the shortest duration so that they will provide maximum benefit to the patient while minimizing the potential for adverse reactions. For most types of anxiety, none of the benzodiazepines is therapeutically superior to any other. Choice of a particular agent is usually made on the basis of pharmacokinetic (Table 30.2) considerations. A benzodiazepine with a long half-life should be considered if the anxiety is intense and sustained. A drug with a short half-life may have advantages when the anxiety is provoked by clearly defined circumsfances and is likely to be of short duration. 

Benzodiazepines, which have a GABA-enhancing effect, have long been the standard treatment for GAD, bnt as discussed earlier, there are the problems of side effects and addictive potential. An antianxiety medication, bnspirone, has been effective in some studies and is FDA-approved for the treatment of GAD (but not for other anxiety disorders snch as... 

Phenothiazines are used to treat psychosis including schizophrenia violent, agitated, disturbed behavior and manic phase of bipolar disorder. Other uses include treatment of pain, headache, hiccups, acute severe anxiety, idiopathic dystonia, withdrawal, taste disorders, leishmaniasis, alleviation of nausea and vomiting, and acute intermittent porphyria. Phenothiazines permit smoother induction of anesthesia, potentiate anesthetic agents, and allow treatment of behavioral symptoms secondary to Alzheimer s disease and senile dementia. Some phenothiazines exert an antipruritic effect and are useful for the treatment of neurodermatitis and pruriginous eczema, and may relieve psychogenic itching. 

Thioxanthenes are used in the treatment of psychosis, including schizophrenia, senile psychosis, pathological jealousy, and borderline personality disorder. Other uses include the treatment of pain, postoperative neuralgia, sedation, anxiety neurosis, childhood behavior problems, and depression. The maximum therapeutic daily oral dose for chlorprothixene, flupenthixol, and thiothixene is 600, 224, and 60 mg respectively the maximum intramuscular dose of each is 200 mg day 100 mg weekly, and 30 mg dayrespectively. Some thioxanthenes and thioxanthenones have shown signs in mice and in vitro assays of possible human therapeutic potential against tumors, and some thioxanthenes have been shown to have cytotoxic and antimicrobial activities. 

First, many of these medications have the potential to be addictive and clients may believe that taking a pill for a quick fix is the recommended course of treatment. Social workers must establish quickly the understanding that supplementing medications with other types of cognitive or behavioral interventions can prove most effective (Cohen Steketee, 1998). For this reason, a behavioral-based contract should be initiated early in the intervention process, preferably before the medication is prescribed. By contracting prior to the medication, the client remains keenly aware that the pill is only one facet of a multidimensional approach to the treatment of anxiety disorders. 

Two medications that have recently become more popular for the treatment of posttraumatic stress disorder (PTSD) and the symptoms of anxiety as well as panic and other conditions are Catapres (clonidine) and Tenex (guanfacine) (Dulcan, 1999). These medications were first used to treat high blood pressure but now have been explored as a potential treatment for a variety of disorders. Generally both of these medicines can help decrease symptoms of hyperactivity, impulsivity, anxiety, irritability, temper tantrums, explosive anger, conduct problems, and tics (Dulcan, 1999). When used with adults, there appears to be support that these medications can help improve self-control as well as increase cooperation with treatment regimens. 

Medications that have been used as treatment for anxiety and depression in the postwithdrawal state include antidepressants, benzodia2epines and other anxiolytics, antipsychotics, and lithium. In general, the indications for use of these medications in alcoholic patients are similar to those for use in nonalcoholic patients with psychiatric illness. However, following careful differential diagnosis, the choice of medications should take into account the increased potential for adverse effects when the medications are prescribed to alcoholic patients. For example, adverse effects can result from pharmacodynamic interactions with medical disorders commonly present in alcoholic patients, as well as from pharmacokinetic interactions with medications prescribed to treat these disorders (Sullivan and O Connor 2004). 

The family Myristicaceae has about 16 genera and 380 species of tropical lowland rainforest trees that are easily recognizable in field collection because of their bloodlike sap, conical crown, and nutmeg-like fruits. A very interesting feature of Myristi-caeae species are their ability to elaborate series of neuroactive indole alkaloids, because it produces neuroactive indole alkaloids, which might hold potential for the treatment of anxiety, mood disorders, and other psychological disturbances. 

One drawback to MAOI therapy is that the therapeutic benefit typically does not begin until after the third week of treatment at the earliest. This is, of course, generally true of all antidepressants that are used to treat panic disorder and other anxiety syndromes. Of greater concern are the potentially dangerous food and drug interactions of the MAOIs (cf. Chapter 3), which have relegated the use of MAOIs for those panic disorder patients who do not respond to other treatments. 

Arguably the first modern class of antidepressants, monoamine oxidase inhibitors (MAOIs) were introduced in the 1950s but are now rarely used in clinical practice because of toxicity and potentially lethal food and drug interactions. Their primary use now is in the treatment of depression unresponsive to other antidepressants. However, MAOIs have also been used historically to treat anxiety states, including social anxiety and panic disorder. In addition, selegiline is used for the treatment of Parkinson s disease (see Chapter 28). 

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