Double anxiety syndrome

FIGURE 8—4. Subsyndromal anxiety can also be a harbinger of an episode of a full generalized anxiety disorder (GAD). Such patients may have an intermittent clinical course, which waxes and wanes over time between subsyndromal anxiety and GAD. Decompensating to full GAD with recovery only to a state of subsyndromal anxiety over time can also be called the double anxiety syndrome. 

Lehmann and coworkers (1989) conducted a three-center, double blind placebo-controlled trial of ( )-kavain (Neuronika ). Of the 56 patients included in the study, four dropped out within the first two weeks of treatment due to reasons unrelated to the study. Of the 52 remaining patients, 21 had a panic syndrome, 17 had generalized anxiety syndrome, 10 disturbance of adaptability, and 4 phobic disturbances. No details were provided in terms of gender. The average age of the total sample was about 40 years. None of the patients were on psychotropic medication for any of the conditions. 

Primary axillary hyperhidrosis Adverse events (in at least 3% of patients) included injection site pain and hemorrhage, nonaxillary sweating, infection, pharyngitis, flu syndrome, headache, fever, neck or back pain, pruritus, and anxiety. Blepharospasm The most frequently reported treatment-related adverse reactions were ptosis (20.8%), superficial punctate keratitis (6.3%), and eye dryness (6.3%). Strabismus Extraocular muscles adjacent to the injection site can be affected, causing ptosis, vertical deviation, spatial disorientation, double vision, or past-pointing, especially with higher doses of botulinum toxin type A. 

Hamilton M, White J Factors related to the outcome of depression treated with ECT. Journal of Mental Science 106 1031-1041, 1960 Hammarback S, Backstrom T Induced anovulation as treatment of premenstrual tension syndrome a double-bhnd crossover study with GnRH-agonist versus placebo. Acta Obstet Gynecol Scand 67 159-166, 1988 Hamon M Neuropharmacology of anxiety-perspectives and prospects. Trends Pharmacol Sci 15(2 36-39, 1994... 

The existence of a withdrawal syndrome was subjected to a controlled test (122) in seven patients who had been taking long-term amitriptyline up to 250 mg/day, imipramine 200 mg/day, or desipramine 250 mg/day. After 4 weeks placebo was substituted double-blind for 10-21 days. Both plasma and urine MHPG concentrations increased by an average of 74% above baseline, starting within 36 hours and reaching a peak 3 weeks after withdrawal. Despite these pronounced neurochemical changes there were no alterations in pulse rate or heart beat, and only two patients had definitely worse anxiety. 

A 49-year-old man had major adverse effects 11 days after taking a combination of sertraline, buspirone, and loxapine (25). The adverse effects were characteristic of the serotonin syndrome, which is characterized by a constellation of symptoms, including hypomania, agitation, seizures, confusion, restlessness, hyper-reflexia, tremor, myoclonus, ataxia, incoordination, anxiety, double vision, fever, shivering, variable effects on blood pressure, nausea and vomiting, sweating, and diarrhea. 

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