Anxiety drug-induced

Table 19.2 Environmental stimuli that induce changes in behaviour which are prevented by anti-anxiety drugs...

The patient experiences anxiety, apathy, bradyphrenia (slowness of thought processes), confusional state, dementia, depression, hallucinosis/psychosis (typically drug-induced), and sleep disorders (excessive daytime sleepiness, insomnia, obstructive sleep apnea, and rapid eye movement sleep behavior disorder). 

In anesthesia drugs from several groups are used as premedication. Pre-anesthetic medication can decrease the anesthetic doses which otherwise would be required to induce anesthesia and so decrease the risk for adverse effects. Pre-anesthetic medication will increase the rate of induction of anesthesia and can reduce pre-operative pain and anxiety. Drugs include benzodiazepines for sedation and their muscle relaxant properties, opiates for pain relieve and anticholinergics or histamine Hi receptor antagonists against nausea and vomiting. Neuroleptics are also used as premedication for their antiemetic effects. 

It is not yet clear how useful, or how detrimental, chronic BZD therapy may be for patients with GAD. Whenever possible, BZD discontinuation (using a gradual tapering schedule) should be attempted to clarify persistence of anxiety or the existence of masked drug-induced adverse effects. Alternative strategies include the following ... 

Psychiatric uses of benzodiazepines other than treatment of anxiety states include the initial management of mania and the control of drug-induced hyperexcitability states (eg, phencyclidineintoxication). Sedative-hypnotics are also used occasionally as diagnostic aids in neurology and psychiatry. 

The promotion of drugs for their drug-induced effects has become less respectable over recent years, especially in the wake of the scandal over benzodiazepine dependence. Although the benzodiazepines are associated with the treatment of anxiety and attempts have been made to articulate a disease-centred account of their action involving the... 

Two of these studies reported that the antidepressant was superior for patients with "retarded" depression, whereas the neuroleptic was superior for anxious or neurotic patients (Hollister et al. 1967 Raskin et al. 1970). This is readily understandable, given what we know of the drug-induced effects of neuroleptics. Their deactivation effects are likely to compound psychomotor retardation and reduce agitation and anxiety. Reserpine, the drug that was believed to induce a depressive state, was found to be clearly superior to placebo for the treatment of depression in an early trial conducted at the Maudsley hospital in London (Davies Shepherd 1955). 

Depression rating scales contain items that are not specific to depression, including sleeping difficulties, anxiety, agitation and somatic complaints. These symptoms are likely to respond to the non-specific sedative effects that occur with most tricyclics and many other antidepressants. Hence changes in rating scale scores may merely reflect drug-induced effects. 

Akathisia is a drug-induced reaction characterized by compelling feelings of restlessness, tension, or anxiety that drive a person to move his or her body (Jeste et al., 1986 Weiner et al., 1983). People with akathisia find it difficult to sit or to keep their feet still. Some will walk in place, pace frantically, or search out activities that keep them on the move. I have evaluated patients with permanent akathisia (tardive akathisia see chapter 4) who, for their entire lives, are trapped in perpetual suffering. The neurological distress produced by this drug-induced condition can become so extreme that even the most spellbound, relatively indifferent patient will feel tortured. 

Benzodiazepines or buspirone for drug-induced anxiety, agitation... 

Adding mirtazapine to venlafaxine or SSRIs may reverse drug-induced anxiety and insomnia... 

Preiiminary data suggest that trazodone may be effective treatment for drug-induced dyskinesias, perhaps in part because it reduces accompanying anxiety... 

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