Phobic anxiety disorders

The section for emotional disorders in children spans across the following diagnoses separation anxiety disorder social anxiety disorder of childhood phobic anxiety disorder of childhood generalized anxiety disorder of childhood other emotional disorders (with onset specific to childhood) and sibling rivalry disorder. 

A hospital nurse is taking imipramine for a phobic anxiety disorder, and her patient is being treated with chlorpromazine for a psychotic disorder. Which of the following adverse effect is likely to occur in both of these individuals ... 

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. 

The anxiety disorders are a case in point. They comprise a range of conditions contiguous with the affective disorders and the stress responses (Table 4.1). Much overlap and comorbidity exist. Furthermore, definitions and diagnostic criteria have changed substantially over the years. For example, generalized anxiety disorder is a rare condition in its pure form, but a common condition if comorbid phobic and depressive disorders are accepted. 

An Australian study compared medical utilization and costs in patients with panic disorder, those with social anxiety disorder, and a control group (Rees et al, 1998). Almost half of the panic disorder patients had seen a primary-care physician more than seven times over a 6-month period, compared with 7% of the social phobic patients and none of the control group. The mean costs were A 150, A 60 and A 20 respectively. The patients with panic disorder were treated with antidepressants (39%), benzodiazepines (15%), relaxants (12%), beta-blockers (7%) and other medication (7%). Twenty per cent received no medication. Patients with panic... 

Kenardy, J., Oei, T.P., Weir, D., and Evans, L., Phobic anxiety in panic disorder Cognition, heart rate, and subjective anxiety. Journal of Anxiety Disorders 7 (4), 359-371, 1993. 

Nalepa I, Kreiner G, Kowalska M, Sanak M, Zelek-Molik A, Vetulani J (2002) Repeated imipramine electroconvulsive shock increase alpha(lA)-adrenoceptor mRNA level in rat prefrontal cortex. Eur J Clin Pharmacol 444 151-159 Nesse RM, Ciu-tis GC, Thyer BA, McCann DS, Huber-Smith MJ, Knopf RF (1985) Endocrine and cardiovascular responses during phobic anxiety. Psychosom Med 47 320-332 Nisenbaiun LK, Zigmund MJ, Sved AF, Abercrombie ED (1991) Prior exposure to chronic stress results in enhanced synthesis and release of hippocampal norepinephrine in response to a novel stressor. J Neurosci 11 1473-1484 Nutt DJ (1989) Altered alpha2-adrenoceptor sensitivity in panic disorder. Arch Gen Psychiatry 46 165-169... 

Anxiety or phobic avoidance that do not meet criteria for any of the specific anxiety disorders... 

Guidance on the clinical indications for benzodiazepine therapy is available from various sources (Task Force Report of the American Psychiatric Association 1990 Ballenger et al. 1998a Bandelow et al. 2002). Long-term therapy is most likely to present problems with discontinuation and is usually reserved for cases that have proved resistant to treatment with antidepressants alone. Patients may benefit from a 2-4 week course of a benzodiazepine whilst antidepressant therapy is initiated, as this counteracts the increased anxiety caused by some drugs (Goddard et al. 2001). A benzodiazepine maybe useful as a hypnotic in some cases of anxiety disorder, and can be used by phobic patients on an occasional basis before exposure to a feared situation. 

Ginsburg, G.S., Silverman, W.K., and Kurtines, W.M. (1995) Family involvement in treating children with phobic and anxiety disorders a look ahead. Clin Psychol Rev 15 457—473. 

King, N.J. (1994) Physiological Assessment. In Ollendick, T.H., King, N.J., and Yule, W. (eds.) International Handbook of Phobic and Anxiety Disorder in Children and Adolescents. Plenum. 

Alcohol is one of the most commonly consumed drugs in the world and has been used by humans since the Stone Age. It is anxiolytic for this reason, it has been used not only for relaxation purposes but also by people with anxiety disorders to suppress their symptoms. Between 10% and 20% of agoraphobic patients are alcohol dependent. Thyrer et al. [1986] reported a 36% prevalence of alcoholism among socially phobic patients entering an anxiety disorders clinic, and [according to population studies] 20%-80% of people with posttraumatic stress disorder [PTSD] are dependent on alcohol. Sierles et al. [1983], in their study of Vietnam War veterans with PTSD, found that 64% were alcohol dependent. Since the Epidemiological Catchment Area study estimated the lifetime prevalence of PTSD to be 1% in the United States population, it is clear that self-medication with alcohol for anxiety symptoms will have a major influence on the development of alcohol dependency [Regier et al. 1990]. 

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. 

Indications Anxiety disorders (especially A and C for panic and phobic disorders) sedation seizure disorders muscle relaxants (D) management of alcohol withdrawal Depression, anxiety disorders (OCD, panic attacks, social phobias, etc.) Generalized anxiety disorders (GAD)... 

Adjustment reaction Phobic disorders Panic disorders Generalized anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder... 

Anxiety states Benzodiazepines with intermediate or long durations of action are favored in the drug treatment of most anxiety states. Alprazolam and clonazepam have greater efficacy than other benzodiazepines in panic and phobic disorders. The anxiolytic effects of buspirone occur without sedation or cognitive impairment but take a week or more to develop. Buspirone is commonly used for generalized anxiety disorders in patients with a past history of substance abuse. 

---