History of Anxiety Disorders

Freud coined the term anxiety neurosis approximately 100 years ago, and all forms of anxiety would be subsumed under that collective diagnostic entity for decades to come. In 1980, based on an emerging literature DSM-111 classified anxiety disorders into several discrete syndromes including panic disorder, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD). 

The irony is that anxiety disorders, which were for so long consolidated into a single diagnostic entity and as recently as two decades ago were treated primarily 

Principles of Psychopharmacology for Mental Health Professionals By Jeffrey E. Kelsey, D. Jeffrey Newport, and Charles B. Nemeroff Copyright 2006 John Wiley Sons, Inc. 

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PTSD is highly comorbid with depression (Kessler et al. 1995) and substance use disorders, and is associated with a previous exposure to trauma and a previous history of anxiety disorders. PTSD probably carries the highest risk of suicide among the anxiety disorders (Davidson et al. 1991). Without effective treatment the disorder generally runs a chronic, unremitting course. 

History of Anxiety Disorders. HealthyPlace Website. Available online at http //www.healthyplace.com/communities/anxiety/paems/panic/ history anxiety disorders. htm. 

There are, however, subgroups of young adults who may not mature out of drug problems as easily as others. Those who seem to have problems maturing out usually have other problems that preceded the onset of drug use. For instance, researchers have found that young adults who have a history of Conduct Disorder or who have other psychiatric disorders (such as schizophrenia, Bipolar Disorder, depression, Anxiety Disorder, or a major personality disorder) mature out of drug problems at much lower rates than those who do not have these additional problems. 

Many patients with anxiety disorders experience an increased susceptibihty to psychosocial stress. Behavioral sensitization may account for these cHnical phenomena, hi the laboratory model of sensitization, single or repeated exposure to physical stimuU or pharmacological agents sensitizes an animal to subsequent stressors (reviewed in Charney et al. 1993). For example, in animals with a history of prior stress, there is a potentiated release of NE in the hippocampus with subsequent exposure to stressors (Nisenbaum et al. 1991). Similar findings were observed in medial prefrontal cortex (Finlay and Abercrombie 1991). The hypothesis that sensitization is underlying neural mechanism contributing to the course of anxiety disorders is supported by clinical studies demonstrating that repeated exposure to traumatic stress is an important risk factor for the development of anxiety disorders, particularly PTSD (Table 1). 

Although anxiety disorders were officially recognized by the American Psychological Association (APA) in 1980, reports of the occurrence of anxiety disorders can be found throughout recorded history. Such prominent figures as Isaac Newton, Emily Dickinson, Abraham Lincoln, and Sigmund Freud all suffered symptoms that would now be classified as an anxiety disorder. 

As the first drugs became available for treatment of mood and anxiety disorders, drugs for mental health became a big business in the United States. In fact, since the 1960s, the history of anxiety and fear disorders has become dominated by research into the drugs used to treat these disorders. 

In a retrospective chart review of 167 patients with a variety of anxiety disorders, excluding patients with evidence of current or previous mood disorder, manic episodes were recorded in five patients, a rate of 3% (20). While this might suggest a clear effect of SSRIs to induce mania, two of the patients were taking clomipramine, a tricyclic antidepressant, albeit a potent serotonin reuptake inhibitor. In addition, all the affected patients had additional diagnoses of histrionic or borderline personality disorder, known to be associated with mood instability. It is still therefore plausible that SSRIs cause mania only in patients with an underlying predisposition, although this may be more subtle than a personal or family history of bipolar illness. 

In general, anxiety disorders are a group of heterogeneous illnesses that develop before age 30 and are more common in women, individuals with social issues, and those with a family history of anxiety and depression. Patients often develop another anxiety disorder, major depression, or substance abuse. The clinical picture of mixed anxiety and depression is much more common than an isolated anxiety disorder. ... 

In agoraphobia with or without panic or with a history of panic disorder, there is a desperate habitual attempt to avoid the specific anxiety-producing stimulus (Nordenberg, 1999). Many times these attempts at avoidance include characteristic patterns and cluster around situations such as being outside the home, in a crowd, in an automobile or other mode of transportation, or being on a bridge (American Psychiatric Press, 1994). 

Bupropion (100 mg p.o. b.i.d.) is indicated in the treatment of depression. It is reserved for patients who cannot tolerate or have not responded to other medications. Bupropion does not alter the uptake of serotonin, has an equivocal effect on the uptake of norepinephrine, but blocks the uptake of dopamine. Bupropion has no affinity for alpha-1 and alpha-2-adrenergic receptors, H,-histamine receptors, muscarinic cholinergic receptors, or D2-dopaminergic receptors. It does not cause sedation or orthostatic hypotension. However, because it is structurally related to amphetamine, it may cause insomnia, agitation, and anxiety shortly after initiation of therapy. Bupropion lowers the seizure threshold and hence is contraindicated in patients with a history of seizure disorder (see also Tables 5 through 7). 

The major psychological adverse effects of cannabis include anxiety, paranoia, and psychosis. Thus, psychological screening should include a detailed psychiatric evaluation to identify individuals with a history of anxiety, paranoia, psychosis, or psychiatric disorders such as depression, manic depression (bipolar), panic disorder, or schizophrenia, which may be exacerbated by cannabis. 

NCS can be a challenging and potentially frustrating syndrome for both the patient and the physician. Even if the cause is benign, recurrent episodes of syncope do not only result in injury, but may provoke substantial anxiety among patients and their families, producing a degree of functional impairment similar to that seen in many chronic debilitating disorders. There are a few data available on the natural history of this disorder and the results of... 

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