Stress disorders

Indeed, 5-HT is also a substrate for the 5-HT transporter, itself an important player in the treatment of depression, and more recently for the whole range of anxiety disorders spectrum (GAD, OCD, social and other phobias, panic and post-traumatic stress disorders). It is the target for SSRIs (selective serotonin reuptake inhibitors) such as fluoxetine, paroxetine, fluvoxamine, and citalopram or the more recent dual reuptake inhibitors (for 5-HT and noradrenaline, also known as SNRIs) such as venlafaxine. Currently, there are efforts to develop triple uptake inhibitors (5-HT, NE, and DA). Further combinations are possible, e.g. SB-649915, a combined 5-HTia, 5-HT1b, 5-HT1d inhibitor/selective serotonin reuptake inhibitor (SSRI), is investigated for the treatment of major depressive disorder. 

OCD, panic disorder, general anxiety disorder, social anxiety disorder, post-traumatic stress syndrome Depression, OCD, panic disorders, post-traumatic stress disorder... 

Clinicians have more recently become more aware of elevated rates of posttraumatic stress disorder (PTSD) in both men and women with opioid dependence (Hien et al. 2000). A lifetime prevalence of PTSD of 20% in women and 11% in men was found in one sample of methadone maintenance patients (Villagomez et al. 1995). Patients often deny a PTSD history during initial assessment. They should be reassessed after they have had the opportunity to develop trust in their treating clinicians. 

Hien DA, Nunes E, Levin FR, et al Posttraumatic stress disorder and short-term outcome in early methadone treatment. J Subst Abuse Treat 19 31-37, 2000 Himmelsbach CK The morphine abstinence syndrome, its nature and treatment. Ann Intern Med 13 829-839, 1941... 

Umbricht A, Hoover DR, Tucker MJ, et al Opioid detoxification with buprenorphine, clonidine, or methadone in hospitalized heroin-dependent patients with HIV infection. Drug Alcohol Depend 69 263-272, 2003 Villagomez RE, Meyer TJ, Lin MM, et al Post-traumatic stress disorder among inner city methadone maintenance patients. Subst Abuse Treat 12 253—257, 1995 Mining E, Kosten TR, Kleber H Clinical utility of rapid clonidine-naltrexone detoxification for opioid abusers. Br J Addict 83 567-575, 1988 Washton AM, Pottash AC, Gold MS Naltrexone in addicted business executives and physicians. J Clin Psychiatry 45 39 1, 1984 Wesson DR Revival of medical maintenance in the treatment of heroin dependence (editorial). JAMA 259 3314-3315, 1988... 

Rates of smoking among patients with bipolar disorders and anxiety disorders (e.g., posttraumatic stress disorder, panic disorder) are also higher than those in the general population (Lasser et al. 2000), but there has been htde smdy of the factors associated with motivation to quit smoking or of smoking cessation interventions in these patient groups. 

Post-traumatic stress disorder (PTSD) is a severe condition with a lifetime prevalence of about 12.5% in women and 6.2% in men (Pigott, 1999). About one in four individuals exposed to trauma develop the syndrome. Drug treatments are still being developed, mostly using antidepressants. Few systematic data are available on the pharmacoeconomics of the condition. 

McCrone P, Knapp M, Cawkill P (2001). Post-traumatic stress disorder (PTSD) in the UK Armed Forces health economic consideration. In press. 

Bandelow B, Zohar J, Hollander E, et al. Guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders. World J Biol Psychiatry 2002 3 171-199. 

PTSD Posttraumatic stress disorder SBGM Self blood glucose monitoring... 

Parry-Jones, B. and Parry-Jones, W., Post-traumatic stress disorder Supportive evidence from an eighteenth century natural disaster. Psychological Medicine 24(1), 15-27, 1994. 

Kramer, T., Lindy, J., Green, B., Grace, M. and Leonard, A., The lombordity of post traumatic stress disorder and suicidality in Vietnam veterans. Suicide and Life Threatening Behaviors 24(1), 58, 1994. 

Spiro, A., Schnurr, P. and Aldwin, C., Combat related post traumatic stress disorder symptoms in older men. Psychology and Aging 9(1), 17-26, 1994. 

Powers, P., Cruse, C., Daniels, S. and Stevens, B., Posttraumatic stress disorder in patients with burns. J Burn Care Rehabil 15(2), 147-153, 1994. 

Blanchard, E., Hickling, E., Taylor, A. and Loos, W., The psychophysiology of motor vechicle accident related posttraumatic stress disorder. Behavior Therapy 25(3), 453-467, 1994. 

Zaslav, M., Psychology or comorbid posttraumatic stress disorder and substance abuse lessons for combat veterans. J Psychoactive Drugs 26(4), 393-400, 1994. 

A prospective, randomized, placebo-controlled trial of paroxetine in adults with chronic post-traumatic stress disorder (PTSD) was recently conducted (Marshall etal., 2007). The subjects were New Yorkers, predominantly female (67%) and Hispanic (65.4%). Seventy subjects entered the study and after a one week placebo lead-in, 52 subjects were randomized to placebo or paroxetine for ten weeks. The subjects were treated with a flexible dosage design (mean dosage, 40.4 mg/day). Dropout rates were 32% for paroxetine and 51.9% for placebo. There were no differences in rates of adverse effects between treatment arms. Paroxetine was superior to placebo in ameliorating the primary symptoms of PTSD (56% vs. 22.2%). 

Pawlyk, A. C., Jha, S. K., Brennan, F. X., Morrison, A. R. Ross, R. J. (2005). A rodent model of sleep disturbances in posttraumatic stress disorder the role of context after fear conditioning. Biol. Psychiatry 57, 268-77. 

Gillin J. C., Smith-Vaniz A., Schnierow B. et al. (2001). An open-label, 12-week clinical and sleep EEG study of nefazodone in chronic combat-related posttraumatic stress disorder. J. Clin. Psychiatry 62, 789-96. 

Doblin, R., A clinical plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD) partnering with the FDA, J. Psychoactive Drugs 34(2), 185-94, 2002. 

Panic disorder Agoraphobia with panic disorder Agoraphobia without panic disorder Specific phobia Social phobia Generalised anxiety disorder Mild anxiety and depression disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD) Adjustment disorder Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia Specific phobia Social phobia (also called social anxiety disorder) Generalised anxiety disorder Obsessive compulsive disorder Acute stress disorder Post-traumatic stress disorder (PTSD)... 

Prozac (Fluoxetine) Depression Obsessive-compulsive disorders Panic Post-traumatic stress disorder 2.9 1.0 1988 - US 1989 - UK Once daily... 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

Clark, R. D., Canive, J. M., Calais, L. A. et al. Divalproex in posttraumatic stress disorder an open-label clinical trial. /. Trauma Stress 12 395-401,1999. 

PCPA parachlorophenylalanine PTSD post-traumatic stress disorder... 

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