Anxiety disorders related conditions

Grant BF, Stinson FS, Dawson DA, et al Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 61 807-816, 2004b... 

Effects of early environmental adversity on HPA mediation of neurodevelopment have also been demonstrated in non-human primates (Coplan et al., 1995). Corticotropin-releasing hormone (CRH) intracerebro-ventricular administration in rhesus monkeys that had been separated from their mothers produced behavioral inhibition and increases in ACTH and cortisol. Coplan et al (1995) presented evidence for persistently elevated cerebrospinal fluid concentrations of corticotropin-releasing factor (CRF) in grown macaques that had been reared by mothers in unpredictable environmental conditions. Further studies in adversely reared adult monkeys demonstrated an inverse relationship between mean CRF concentrations and GH response to clonidine (Coplan et al., 2000). In light of evidence that reduced GH response to clonidine has been shown in other anxiety disorders (Charney and Bremner, 1999), Coplan et al. (2000) hypothesize that GH response to clonidine may inversely reflect trait-like increases of central nervous system CRF activity. Data linking childhood anxiety to growth deficits are consistent with this view (Pine et al., 1996). Activity, of the HPA axis, as related to early environmental... 

This principle is not applicable in biological psychiatry. One can and should not simply discard the possibility that a biological variable observed in a psychotic condition is linked to a concurrent depression or that one found in depression is in fact related to a comorbid anxiety disorder. The hierarchical principle is a deus ex machina that resolves the problem of comorbidity only in appearance. Comorbidity in itself is merely a descriptive, not an explanatory, term. The multiplicity of psychiatric disorders, as they are presently defined, in so many patients permits a variety of explanations (Van Praag 1996], and thus the term comorbidity conceals more than it discloses. 

Psychotic, eating, or mood disorders in which anxiety is related to the underlying condition... 

Anxiety disorders substantially diminish one s quality of life and ability to function ( 24). In the attempt to manage anxiety-related phenomena, as well as sleep disturbances, various treatments (both drug and nondrug) have been used over the course of history. Today, our understanding of the basis for such conditions is becoming more refined, allowing identification of differentiating qualities that will ultimately dictate more specific and effective remedies as discussed in Chapter 12. 

These medications are used by clinicians to treat a wide range of anxiety-related conditions, including separation anxiety, school phobia, and panic disorder. None of these agents, however, has been the subject of systematic, double-blind, placebo-controlled studies in children or adolescents, and opinions about their effectiveness depend primarily on anecdotal experience and reports. 

Some of the growth in antidepressant use may be related to the broad application of these agents for conditions other than major depression. For example, antidepressants have received FDA approvals for the treatment of panic disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). In addition, antidepressants are commonly used to treat pain disorders such as neuropathic pain and the pain associated with fibromyalgia. Some antidepressants are used for treating premenstrual dysphoric disorder (PMDD), mitigating the vasomotor symptoms of menopause, and treating stress urinary incontinence. Thus, antidepressants have a broad... 

Using benzodiazepines to treat anxiety requires knowledge of how to balance the risks of these agents rationally against their benefits and to compare this with other available therapeutic interventions. For short-term anxiety-related conditions, such as an adjustment disorder with onset after a stressful life event, benzodiazepines can provide rapid relief with little risk of dependence or withdrawal if use is limited to several weeks to a few months. However, for conditions likely to require treatment... 

Post traumatic stress disorder (PTSD) is the only psychiatric condition whose definition demands a particular stressor to precede its appearance. Unlike the other anxiety disorders, it is only in the past decade that the biology of PTSD has come under scrutiny. Furthermore, although PTSD can occur following various traumatic events (for example, sexual abuse, accidents and torture), most emphasis has been placed on combat-related disorders. 

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). 

Studies clearly support that the neurochemical-based treatments for depression such as antidepressant medications and ECT are effective in lifting depressed moods. Controlled studies using neurochemically based treatments specifically for the treatment of major depression indicated that 78% of the depressed individuals improved with ECT, and 70% with the newer antidepressants medications (Maxmen Ward, 1995). In practice, it is estimated that 50% of individuals who take antidepressant medicines report feeling better or achieve complete remission. In addition, antidepressant medications can be used to treat related conditions such as obsessive compulsive disorder and overwhelming anxiety (Brophy, 1991). Antidepressants are often used to treat excessive anxiety since they can block the symptoms of panic including rapid heartbeat, terror, dizziness, chest pains, nausea, and breathing problems. 

When dealing with individuals who suffer from the anxiety-related conditions, a physical exam is essential. A physical exam is needed to determine and address the multifaceted symptoms that often coexist in individuals who suffer from the anxiety disorders. For example, it can be difficult to differentiate symptoms related to anxiety from those related to medical conditions such as heart difficulties, asthma, and hypertension. Clear identification of these symptoms is important because these medical conditions can produce anxiety-like symptoms that confuse both the client and the health care professional. Professionals agree that a thorough medical examination is needed to rule out potential physiological difficulties and to assist in preparing for the psychosocial strategies that will follow. 

ADHD should not be diagnosed if the symptoms can be better accounted for by other mental disorders, such as mood disorder, Tourette s syndrome, anxiety disorder, dissociative disorder, personality disorder, personality change due to a general medical condition, or a substance-related disorder (e.g., due to bronchodilators, isoniazid, akathisia from neuroleptics). Moreover, ADHD is not diagnosed when symptoms occur exclusively during the course of a pervasive developmental disorder or psychotic disorder (American Psychiatric Association, 2000). Conditions other than ADHD, such as neurofibromatosis, fetal alcohol syndrome and lead poisoning, of which ADHD features are typical symptoms (Pearl et al., 2001), should also be ruled out. 

Buckner JD, Heimberg RG, Schneier FR, liu S, Wang S, Blanco C. The relationship between cannabis use disorders and social anxiety disorder in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Drug Alcohol Depend 2012 124 128-34. 

Symptoms of anxiety and panic are commonly associated with a dependency on life support, communication difficulties, and uncertainty regarding health status (2). Many patients meet the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-fV) criteria for diagnosis of an anxiety disorder or a panic disorder. Posttraumatic stress disorder is sometimes the result of being close to death as well as the subsequent ICU experiences (3). If unmanaged, such psychiatric conditions will have important clinical consequences on adherence to recommended care and participation in rehabilitation. They will undoubtedly also influence health-related quality of life. 

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