Anxiety medically induced

Ethanol (ethyl alcohol) has central nervous system depressant properties and is widely used to relieve anxiety and produce sedation. Although some medical practitioners occasionally prescribe an alcoholic beverage for relieving minor anxiety and inducing sleep, individuals frequently self-medicate with ethanol. Many individuals who abuse alcohol may have started using it to relieve symptoms of central nervous system disorders, such as anxiety and depression. 

Benzodiazepines and other anxiolytics. Although benzodiazepines are widely used in the treatment of acute alcohol withdrawal, most nonmedical personnel involved in the treatment of alcoholism are opposed to the use of medications that can induce any variety of dependence to treat the anxiety, depression, and sleep disturbances that can persist for months following withdrawal. Researchers have debated the pros and cons of the use of benzodiazepines for the management of anxiety or insomnia in alcoholic patients and other substance abuse patients during the postwithdrawal period (Ciraulo and Nace 2000 Posternak and Mueller 2001). 

Substance-Induced Anxiety Disorder. Numerous medicines and drugs of abuse can produce panic attacks. Panic attacks can be triggered by central nervous system stimulants such as cocaine, methamphetamine, caffeine, over-the-counter herbal stimulants such as ephedra, or any of the medications commonly used to treat narcolepsy and ADHD, including psychostimulants and modafinil. Thyroid supplementation with thyroxine (Synthroid) or triiodothyronine (Cytomel) can rarely produce panic attacks. Abrupt withdrawal from central nervous system depressants such as alcohol, barbiturates, and benzodiazepines can cause panic attacks as well. This can be especially problematic with short-acting benzodiazepines such as alprazolam (Xanax), which is an effective treatment for panic disorder but which has been associated with between dose withdrawal symptoms. 

Primary care physicians are critical to the successful identification of GAD. Characterized by often-vague physical complaints, GAD must be distinguished from medical illnesses and other psychiatric disorders, though the high rate of comorbidity requires that a thorough evaluation for GAD be completed even when another disorder has been identified. GAD warrants particular consideration for those patients with nonspecific physical complaints who nevertheless have an urgent need for relief that has resulted in repeated office visits. The differential diagnosis for GAD includes other anxiety disorders, depression, and a variety of medical conditions and substance-induced syndromes. 

Once chronic insomnia has developed, it hardly ever spontaneously resolves without treatment or intervention. The toll of chronic insomnia can be very high and the frustration it produces may precipitate a clinical depression or an anxiety disorder. Insomnia is also associated with decreased productivity in the workplace and more frequent use of medical services. Einally, substance abuse problems may result from the inappropriate use of alcohol or sedatives to induce sleep or caffeine and other stimulants to maintain alertness during the day. 

The closest things to true antiserotonin medications used by psychiatrists are those used to treat serotonin-induced side effects. In particular, cyproheptadine has an overall serotonin-blocking effect. With repeated use, this medication can theoretically cause depression and anxiety, and there are case reports of recurrence of depressive symptoms following frequent administration of cyproheptadine. 

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. 

SRls are currently the most prevalent pharmacological treatment used for panic disorder [see Westenberg and Den Boer, Chapter 24, in this volume], even though tricyclic antidepressants, monoamine oxidase inhibitors [MAOls], and benzodiazepines are also effective. The efficacy of the SRI antidepressants and the observation that initially they may induce deterioration of symptoms [which is usually not the case with treatment of depressed patients with the same medications] raise issues related to the pathobiology of anxiety and its comorbidity with depression. 

The sleep disorders are categorized into primary disorders (i.e., dyssomnias and parasomnias), those related to another mental disorder, those related to a general medical disorder, and those that are substance induced. Like anxiety, disturbances of sleep affect nearly all of us at one time or another. Also like... 

Bonnet-Brilhault et al. (1998) also presented a case of paroxetine-induced akathisia. They terminated the treatment with a complete resolution of the problem. They observed that in most cases the first and best option is to discontinue the offending agent. LaPorta (1993) treated two cases of sertraline-induced akathisia that cleared up after terminating the medication. Olivera (1996) described a case of paroxetine-induced akathisia that was mistaken for an exacerbation of the patient s so-called panic anxiety The dose was doubled, and the condition worsened. The akathisia resolved when paroxetine was replaced by clomipramine. 

The original 1989 Prozac label, under the heading Adverse Reactions of the Nervous System, mentions akathisia as infrequent. However, in the September 1989 issue of the Journal of Clinical Psychiatry, Joseph Lipinski et al. from McLean Hospital and Harvard Medical School described five cases of Prozac-induced akathisia, which they believed occurred fairly frequently. They estimated the rate of akathisia in Prozac patients at between 9.7% and 25%. They stated that their cases were indistinguishable from neuroleptic-induced akathisia. In a case example, 5 days after starting Prozac, one woman reported severe anxiety and restlessness. She paced the floor throughout the day, found sleep at night difficult because of the restlessness, and constantly shifted her legs when seated. ... 

GHB is an intoxicating chemical that is used for recreational, criminal, and medical uses. Users report that GHB induces a state of relaxation and tranquillity. Frequently reported effects include placidity, mild euphoria, and a tendency to verbalize. Users say that anxieties and inhibitions tend to dissolve into a feeling of emotional warmth, well-being, and drowsiness. 

Anxiety disorder due to a general medical condition Substance-induced anxiety disorder Anxiety disorder not otherwise specified... 

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