Generalized anxiety disorder evaluation

Lecrubier Y, Judge R Long-term evaluation of paroxetine, clomipramine and placebo in panic disorder. Acta Psychiatr Scand 95 153-160, 1997 Lecrubier Y, Puech AJ, Azcona A, et al A randomized double-blind placebo-con-trolled study of tropisetron in the treatment of outpatients with generalized anxiety disorder. Psychopharmacology 112 129, 1993 Lecrubier Y, Pletan Y, Selles A, et al Clinical efficacy of milnacipran placebo-con-trolled trials. Int Chn Psychopharmacol 11 (suppl 4 29-34, 1996 Lecrubier Y, Bakker A, Dunbar G, et al A comparison of paroxetine, clomipramine and placebo in the treatment of panic disorder. Acta Psychiatr Scand 95 145-152, 1997... 

Lydiard RB, Ballenger JC, Rickels K. A double-blind evaluation of the safety and efficacy of abecarnil, alprazolam, and placebo in outpatients with generalized anxiety disorder. Abecarnil Work Group. J Clin Psychiatry 1997 58(suppl 11) 11-18. 

Fontaine R, Beaudry P, Le Morvan P, Beauclair L, Chouinard G (1990) Zopiclone and triazolam in insomnia associated with generalized anxiety disorder a placebo-controlled evaluation of efficacy and daytime anxiety. Int Clin Psychopharmacol 5 173-183... 

In another study, Malsch and Kieser (2001) investigated the anxiolytic effects of WS 1490 compared to placebo in patients previously treated with a benzodiazepine. They evaluated the potential of the kava preparation as a replacement for the benzodiazepine, as well as the ability of the kava preparation to reduce benzodiazepine withdrawal symptoms. This was a five-week randomized, double blind placebo-controlled study in outpatients with non-psychotic anxiety (e.g., generalized anxiety disorder, social phobia, and simple phobia). Forty patients were included, and all had been on benzodiazepines (i.e., lorazepam, bromazepam, oxazepam, or alprazolam) for a mean duration of 20 months prior to entering the study. Of the 40 patients, 25 were males, and the mean age of the total sample was 40 years (range 21—75 years). 

More recently, Connor and Davidson (2002) evaluated the efficacy and safety of kava in treating generalized anxiety disorder (GAD). Thirty-seven adults who met the DSM-IV criteria for GAD were randomly assigned to four weeks of double blind treatment with kava or a matching placebo. Treatment was initiated at 70mg kavalactones (kl) twice a day for one week (140 mg kl/day) and increased to 140 mg kl twice a day (280 mg kl/day) for the next three weeks. Weekly efficacy assessments using the HAMA, Self Assessment of Resilience and Anxiety (SARA Barnett etal., 2001) and... 

The Fear Questionnaire (FQ) is a 24-item self-rated scale used mainly for assessments in phobias. One component of the scale evaluates phobic behavior associated with a number of situations, whereas another component assesses symptoms of anxiety, depression and general distress caused by phobia (Marks and Mathews, 1979). The social phobia, strongly related to social anxiety, and most of the subscales are significantly related to neuroticism. The FQ has been utilized in several trials of social anxiety disorder. 

For MDD with severe anxiety, mirtazapine, TCAs, trazodone, and benzodiazepines should be considered as adjunctive therapy. If the patient is not at least moderately improved after 4-8 weeks, the treatment regimen should be reappraised. Compliance should be checked. It is important to consider pharmacokinetic/pharmacodynamic factors (this may require an evaluation of serum levels of the antidepressant medication), general medical comorbidities, and comorbid psychiatric disorders, including substance abuse and significant psychosocial problems. The initial therapeutic treatment dose should be gradually maximized. For partial responders, the trial should be extended by... 

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