Autonomic symptoms

Dysautonomia may produce orthostadc hypotension, sphincter abnormalides and sexual dysfuncdon. Orthostadc hypotension, pardcularly problemadc in PD and Parkinson-plus syn- 

Dysautonomia may produce orthostatic hypotension, sphincter abnormalities and sexual dysfunction. Orthostatic hypotension, particularly problematic in PD and Parkinson-plus syn- 

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Anxiety is a normal reaction. Pathological anxiety interferes with daily-life activities and may be accompanied by autonomic symptoms (chest pain, dyspnoea and palpitations). Severe forms include phobic anxiety and panic disorder. 

Patients with nausea often complain of autonomic symptoms such as diaphoresis, general disinterest in surroundings, pallor or faintness, and salivation. 

A = Autonomic symptoms (drooling, constipation, sexual dysfunction, urinary problems, sweating, orthostatic hypotension, dysphagia)... 

Migraine is a common, recurrent, primary headache of moderate to severe intensity that interferes with normal functioning and is associated with GI, neurologic, and autonomic symptoms. In migraine with aura, a complex of focal neurologic symptoms precedes or accompanies the attack. 

The BZs are the most frequently prescribed drugs for the treatment of acute anxiety (Table 68-9). All BZs are equally effective anxiolytics, and most of the improvement occurs in the first 2 weeks of therapy. They are considered to be more effective for somatic and autonomic symptoms of GAD, while antidepressants are considered more effective for the psychic symptoms (e.g., apprehension and worry). 

Blockers blunt the peripheral autonomic symptoms of arousal (e.g., rapid heart rate, sweating, blushing, and tremor) and are often used to decrease anxiety in performance-related situations. For specific SAD, 10 to 80 mg of propranolol or 25 to 100 mg of atenolol can be taken 1 hour before the performance. A test dose should be taken at home on a day before the performance to be sure adverse effects will not be problematic. 

The anticonvulsant effect, as well as the hypertensive activity of yohimbine have also been studied (343, 344). It has been shown that yohimbine produces significant increases in subjective anxiety, autonomic symptoms, and blood pressure (345). 

Beta Blockers. Most often used to treat hypertension, beta blockers also alleviate many of the readily visible physical (i.e., autonomic) symptoms of anxiety. Namely, these medications decrease the sweating, palpitations, racing pulse, dry mouth, and tremulousness that can accompany anxiety. Although beta blockers do not remedy the emotional aspects of anxiety, they can circumvent the spiraling anxiety of patients with social phobia who during performance situations become self-conscious of their readily evident physical symptoms. 

Neuroleptic malignant syndrome is a rare condition which can occur even after the single administration of antipsychotics. It manifests itself with hyperpyrexia, muscle rigidity, autonomic symptoms, clouding of consciousness and it has a mortality rate of over 10%. The aetiology is unknown but dopamine blockade may play a role. 

FIGURE 8—12. Overactivity of norepinephrine neurons is associated with anxiety and may mediate the autonomic symptoms associated with anxiety, such as tachycardia, dilated pupils, tremor, and sweating. Shown here are hyperactive norepinephrine neurons with their axons projecting forward to the cerebral cortex from their cell bodies in the locus coeruleus. 

FIGURE 8—13. If an alpha 2 agonist such as clonidine, is administered, it will have much the same action as norepinephrine (NE) itself both at somatodendritic alpha 2 autoreceptors and at terminal alpha 2 autoreceptors. This action is that of reducing both neuronal impulse in NE neurons and release of NE from noradrenergic axon terminals. Thus, alpha 2 agonists will decrease the symptoms associated with anxiety, especially the autonomic symptoms of dilated pupils, tachycardia, tremor, and sweating. 

In 304 insulin-treated patients, 8.2% of those with type 1 diabetes and 2.2% of those with type 2 diabetes had blood glucose concentrations below 4 mmol/1 on arrival in the clinic (66). None had complained of symptoms of hypoglycemia or had taken glucose, but when questioned, 59% had autonomic symptoms and 12% had neuroglyco-penic symptoms 29% were asymptomatic. 

This term is used to describe the phenomenon in which abnormal behavioural and autonomic symptoms occur when the drug is abruptly withdrawn or its effects are terminated by the administration of a specific antagonist. Most drugs of abuse (e.g. the opioids, sedatives, alcohol) produce some physical dependence, although withdrawal symptoms are relatively mild following the abrupt withdrawal of cannabis, the stimulants, and cocaine. 

Paper chromatography or more of 12 autonomic symptoms (e.g. shortness of breath, dizziness, palpitations, sweating). Separation of a mixture of compounds on filter paper according to their relative solubility in organic solvents that diffuse through the paper by capillary action. 

Physical dependence Phenomenon in which abnormal behavioural and autonomic symptoms occur following the abrupt withdrawal of a drug of dependence or when the effect of the drug is terminated by means of a specific antagonist. 

Autonomic symptoms are most common and include gastrointestinal disturbance (nausea, diarrhea), general somatic distress (myalgias, malaise, headache, rhinorrhea), sleep disturbances (insomnia, nightmares), and cardiovascular symptoms (arrhythmias, ventricular ectopy). Psychotic decompensation, withdrawal mania, and general anxietylike symptoms have been attributed to abrupt withdrawal of cyclic antidepressants. 

Prolonged toxic delirium related to disulfiram and alcohol intake has been reported (237). The predominant presenting feature was neuropsychiatric rather than autonomic symptoms. 

BZs should be reserved for patients at low risk of substance abuse, those who require rapid relief, or those who have not responded to other therapies. Clonazepam is the most extensively studied BZ for treatment of generalized SAD. It improved fear and phobic avoidance, interpersonal sensitivity, fears of negative evaluation, and disability measures. Adverse effects include sexual dysfunction, unsteadiness, dizziness, and poor concentration. Clonazepam should be tapered at a rate not to exceed 0.25 mg every 2 weeks. Gabapentin was effective for SAD, and onset of effect was 2 to 4 weeks. j8-Blockers blunt the peripheral autonomic symptoms of arousal (e.g., rapid heart rate, sweating, blushing, and tremor) and are often used to decrease anxiety in performance-related situations. For specific SAD, 10 to 80 mg of propranolol or 25 to 100 mg of atenolol can be taken 1 hour before the performance. A test dose should be taken at home on a day before the performance to be sure adverse effects wUl not be problematic. Incomplete response to a first-line agent may benefit from augmentation with buspirone or clonazepam. 

May block the autonomic symptoms in anxiety and panic disorders (e.g., palpitations, sweating) and improve subjective anxiety as well... 

Disulfiram (tetraethylthiuram) has been widely used since the late 1940s to facilitate abstinence from alcohol (1). Concomitant use of alcohol during disulfiram therapy results in an autonomic symptom complex that can involve headache, flushing, nausea and vomiting, sweating, tachycardia, hypotension, and confusion. The mechanism of action of disulfiram is inhibition of aldehyde dehydrogenase alcohol is metabolized to acetaldehyde, which accumulates (2). 

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