Anxiety disorders posttraumatic stress disorder

Clinicians will readily recognize in Table 3.7 the experiences reported by many of their patients when receiving treatment for depression or other related psychiatric disorders. By looking at the Function affected column, it is possible to understand why some medications (say, SSRIs) are effective in variable degrees in several conditions associated with serotonin dysfunction (depression, OCD, social anxiety disorder, posttraumatic stress disorder, generalized anxiety disorder, panic disorder, and bulimia nervosa). 

Humans were not untouched by this disaster. Visits to community clinics for primary care and mental health services in the affected area increased dramatically after the spill (Impact Assessments, 1990). Exposure to the incident was shown to have a profound impact on the prevalence of psychiatric disorders with increased rates of generalized anxiety disorder, posttraumatic stress disorder, and depressive symptoms present in the population (Palinkas, Petterson, Russell, Downs, 1993). 

Panic disorder, posttraumatic stress disorder, social anxiety disorder PO Adults, Elderly. 

Clinical experience suggests that nefazodone may also be useful in panic disorder, posttraumatic stress disorder, and generalized anxiety disorder, but without the 5HT2A-activating side effects associated with the SSRIs. 

Data from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC American Psychiatric Association, 2000 429-484 and Ballenger JC, Davidson JRT, Lecrubier Y, etai Consensus statement update on posttraumatic stress disorder from the International Consensus Croup on Depression and Anxiety. J (Tin Psychiatry 2004 65(Suppi l) 55-62. 

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. 

Mental disorders, for example, multiple subtypes of anxiety, chronic fatigue syndrome, depression, sometimes together with chronic pain, posttraumatic stress disorders (PTSD), and schizophrenia... 

Southwick SM, Krystal JH, Bremner JD, Morgan CA, Nicolaou A, Nagy LM, Johnson DR, Heninger GR, Charney DS (1997) Noradrenergic and serotonergic fimction in posttraumatic stress disorder. Arch Gen Psychiatry 54 749-758 Stein MB, Tancer ME, Uhde TW (1992) Heart rate and plasma norepinephrine responsivity to orthostatic challenge in anxiety disorders. Comparison of patients with panic disorder and social phobia and normal control subjects. Arch Gen Psychiatry 49 311-317 Stein MB, Huzel LL, Delaney SM (1993) Lymphocyte b-adrenoceptors in social phobia. Biol Psychiatry 34 45-50... 

Anxiety represents a state of heightened vigilance and fear, but pathological anxiety can be distinguished from fear in that it is inappropriately evoked and may persist in the absence of real threat or danger. The study of conditioned fear has provided detailed information on the neural circuitry and intracellular mechanisms that are important to fear responses and their long-term retention. The description of neural circuitry and the mechanisms underlying disorders of fear memory such as posttraumatic stress disorder (PTSD) may also be relevant to other anxiety states that share common neural substrates. 

Posttraumatic stress disorder (PTSD) refers to a pattern of anxiety, distress, and avoidance following an event experienced as threatening and/or intensely distressing. This disorder has been reported to have behavioral (Zaidi and Foy, 1994) and neurobiological effects into adulthood (Charney and Bremner, 1999). Much of the developmental research on the condition derives from retrospective studies of adults. The many possible biases inherent in such research preclude the generation of firm conclusions on the developmental course of the condition. An important process in the study of PTSD will be to identify the developmental path of the disorder in the context of the prevalence of anxiety disorders in childhood (Costellot et ah, 1996 Pynoos et ah, 1999). 

Brophy, M.H. (1991) Cyproheptadine for combat nightmares in posttraumatic stress disorder and dream anxiety disorder. Mil... 

Posttraumatic stress disorder (PTSD) is another anxiety disorder that can be characterized by attacks of anxiety or panic, but it is notably different from panic disorder or social phobia in that the initial anxiety or panic attack is in response to a real threat (being raped, for example) and subsequent attacks are usually linked to memories, thoughts, or flashbacks of the original trauma. The lifetime incidence of PTSD is about 1%. Patients have disturbed sleep and frequent sleep complaints. Comorbidities with other psychiatric disorders, especially depression and drug and alcohol abuse, are the rule rather than the exception. The DSM-IV diagnostic criteria are given in Table 9—11. 

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. 

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

Ballenger, JC, Davidson, JRT, Lecrubier, Y, Nutt, DJ, Marshall, RD, Nemeroff, CB, Shalev, AY, Yehuda, R. Consensus Statement Update on Posttraumatic Stress Disorder From the International Consensus Group on Depression and Anxiety. Journal of Clinical Psychiatry, 65(Suppl. l) 55-62, 2004... 

Lee HJ, Lee MS, Kang RH, et al. Influence of the serotonin transporter promoter gene polymorphism on susceptibility to posttraumatic stress disorder. Depress Anxiety 2005 21 135-9. 

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