Anxiety state

The diagnostic criteria for, and general features of, disorders in which anxiety is a prominent component are described in detail in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV, 4th edition (1994)) and are regarded as either phobias or anxiety states ... 

The evidence outlined so far does little to explain how monoamines or anti-anxiety drugs might influence anxiety states. To achieve this, an integrated view of the relevant brain systems is required, together with an appreciation of how their function is regulated. 

Many individuals use alcohol as a short-term means for coping with social and other anxieties, but this can paradoxically lead to harmful drinking and far greater problems. Patients with phobic anxiety are particularly at risk for developing alcohol problems. In addition, the symptoms of alcohol withdrawal may mimic those of an anxiety state the dependent drinker may complain of feeling anxious and restless in the... 

Murphy JE. (1978). Mianserin in the treatment of depressive illness and anxiety states in general practice. BrJ Clin Pharmacol. 5(suppl 1) 81S-85S. 

With regard to generalized anxiety disorder, it has been postulated that an overactivity of the stimulatory 5-HT pathways occurs. Drugs such as buspirone and ipsapirone are effective in such conditions because they stimulate the inhibitory S-HT a autoreceptors on the raphe nuclei and thereby reduce serotonergic function. It is noteworthy that the SSRIs often worsen anxiety initially because they temporarily enhance serotonergic function. Adaptive changes in the pre- and postsynaptic 5-HT receptors then occur leading to a reduction in the anxiety state. 

Noradrenaline is the neurotransmitter most closely associated with the peripheral and central stress response (Figure 9.5). There is experimental evidence to show that drugs such as yohimbine that block the noradrenergic autoreceptors (e.g. on cell bodies and nerve terminals) and thereby enhance noradrenaline release cause fear and anxiety in both man and animals. Conversely, drugs that stimulate these autoreceptors (as exemplified by clonidine) diminish the anxiety state because they reduce the release of noradrenaline. Benzodiazepines have been shown to inhibit the fear-motivated increase in the functional activity of noradrenaline in experimental animals, but it is now widely believed that the action of the benzodiazepines on the central noradrenergic system is only short term and may contribute to the sedative effects which most conventional benzodiazepines produce, at least initially. Nevertheless, altered noradrenergic... 

Phenobarbitone is used to treat epilepsy, migraine headache, dental infections, pregnancy vomiting, tetanus, enuresis, chorea, pre and post operative sedation, hypertension, anxiety states, neurosis, and in the treatment of drug and alcohol addiction. This drug is also called phenobarbital. 

Therapeutic indications for benzodiazepines include anxiety states associated with neurotic, phobic, and depressive disorders, or myocardial infarction (decrease in cardiac stimulation due to anxiety) insomnia preanesthetic (preoperative) medication epileptic seizures and hypertonia of skeletal musculature (spasticity, rigidity). 

Long-term use Prolonged use of ephedrine may produce a syndrome resembling an anxiety state many patients develop nervousness a sedative may be needed. Acute symptoms Do not use salmeterol to relieve acute asthma symptoms. If the patient s short-acting, inhaled 2-agonist becomes less effective (eg, the patient... 

Pregabaline is primarily an antiepileptic. Although it is an analogue of the neurotransmitter GABA it is not a GABA-agonist. It is mentioned here because it is also approved for use in generalized anxiety states. 

Ferre P, Fernandez-Teruel, Escorihuela RM, DriscoU P, Corda MG, Giorgo O, Tabena A (1995) Behavior of the Roman/Verh high- and low-avoidance rat lines in anxiety-tests relationship with defecation and self-grooming. Physiol Behav 58 1209-1213 FUe SE (1995) Animal models of different anxiety states. In Biggio G, Sanna E, Costa E (eds) GABAa receptors and anxiety from neurobiology to treatment. Raven Press, New York, pp 93-113... 

The behavior of tacl mice was also analyzed in several animal models of anxiety. The open-field test is a widely used tool for behavioral research, but less specific for the evaluation of the anxiety state of the animal, because it is a summation of the spontaneous motor and the exploratory activities, and only the latter is influenced by the anxiety level (Choleris et al. 2001). Under aversive environmental conditions (high level of illumination) the animals activity is strongly affected by the emotional state, while less aversive situations (familiar, dimly lit environment) are useful to assess the general motor activity of mice. Because rodents avoid open areas, the activity of mice in the central part of the open-field arena is inversely correlated to the anxiety level. Tad mice spent only 6.5% of their total activity in the central part, which represented 11% of the total field, indicating that they avoided this aversive area, hi contrast, tacl mice spent 13.6% of their activity in the central area (Bilkei-Gorzo et al. 2002). The increased central activity of the tad mice indicates that the test situation was anxiogenic for tad animals, but less so for the knockout mice. 

Tad mice were also studied in the zero-maze test, which is considered to provide a specific and sensitive readout of the anxiety state of an animal. The zero-maze device consists of an elevated annular platform, divided into two... 

In this chapter, we consider categorical anxiety disorders as defined by the standardized diagnostic criteria of American Psychiatric Association s Diagnostic and Statistical Manual for Psychiatric Disorders [i.e., DSM-III (1980), DSM-III-R (1987), DSM-IV (1994)]. The subtypes of anxiety states included are panic disorder, agoraphobia, specific phobia, social phobia, generahzed anxiety/overanxious disorder, separation anxiety, and obsessive-compulsive disorder. 

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. 

Commons K, Valentio R (2002) Cellular basis of substance P in the periaqueductal gray and dorsal raphe nucleus. J Comp Neurol 447 82-97 Conti L, Pinder R (1979) A controlled comparative trial of mianserin and diazepam in the treatment of anxiety states in psychiatric outpatients. J Int Med Res 7 185-189 Coyle J, Leski M, Morrison J (2002) The diverse roles of L-glutamic acid in brain signal transduction. In Davis K, Charney D, Coyle J, Nemeroff C (eds) Neuropsychopharmacology and the fifth generation of progress. Lippincott Williams and Wilkins, Philadelphia, pp 71-90... 

Evidence of noradrenergic involvement in panic disorder includes results from studies on the growth hormone axis, the cardiovascular system, and the homeostatic control of the noradrenergic axis. A review of these three areas is presented below. To illustrate the manner in which the environment may interact with the noradrenergic axis, the review of these three areas integrates research on panic disorder with research on children who may be at risk for panic disorder and with research on nonhuman primate models of human anxiety states. 

Studies on the noradrenergic axis in nonhuman primates provide evidence that early environmental stressors may provoke biological and behavioral phenocopies of human clinical anxiety states. We have used the primate model of developmental psychopathology pioneered by Rosenblum et al. (1991) to explore this issue. Nonhuman primates who were reared as infants by mothers undergoing environmental stress induced by unpredictable or variable foraging demand (VFD-reared) conditions were compared with nonhuman primates reared as infants by mothers exposed to predictable (either low [LFD-reared] or high [HFD-reared]) foraging demand conditions. 

Benzodiazepines, the most commonly used anxiolytic drugs in the treatment of chronic anxiety states, have also been investigated in the treatment of social phobia. These agents have been shown to be effective in the treatment of other anxiety disorders, including panic disorder and generalized anxiety disorder. Three benzodiazepines, all in the high-potency class of benzodiazepines have been investigated in the treatment of social phobia. 

THERE AN ALTERED FUNCTION OF THE CHOLECYSTOKININ SYSTEM IN ANXIETY STATES IN HUMANS ... 

File SE Animal models of different anxiety states. Adv Biochem Psychopharmacol 48 93-113, 1995... 

Gulley LR, Nemeroff CB The neurobiological basis of mixed depression-anxiety states. J Clin Psychiatry 54 [supplj 16-19, 1993 Gur RC, Gur RE, Obrist WD, et al Sex and handedness differences in cerebral blood flow during rest and cognitive activity. Science 217 659-661, 1982 Guttmacher LB, Murphy DL, Insel TR Pharmacologic models of anxiety. Compr Psychiatry 24 312-326, 1993... 

Hamilton M The assessment of anxiety states by rating. Br J Med Psychol 32 50-55,... 

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