Anxiety and Panic Attacks Natural Treatment

Panic Away System

Panic Away, developed by Barry Joseph McDonagh uses the 21/7 technique. It means doing a twenty one second countdown followed by seven second exercise. These are easy and can be done anywhere. Moreover, there are a number of different exercises too, both mental (including affirmations, visualization, and breathing techniques) and physical to help the stages along. The two main goals of Panic Away are to stop panic attacks and to eliminate general anxiety and the 21 7 Technique is the core of the Panic Away program. Barry McDonagh describes the 21 7 technique as first aid for anxiety and it is made up of two components: 1. The 21 Second Countdown Technique which is designed to stop panic attacks, and 2. The Seven Minute Exercise which is designed to reduce general feelings of anxiety. The best thing about this eBook is that its simple and detailed course. Moreover, audio series, video presentations, 60-Day money back Guarantee, members forum and the one on one coaching and counseling with Barry made this program very affordable for me. Continue reading...

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Anxiety Disorders

7 A Unique Vulnerability Common to All Anxiety 8 Cognitive Vulnerability to Panic Disorder 207 Norman B. Schmidt and Kelly Woolaway-Bickel 10 Cognitive Vulnerability to Social Anxiety Disorder 251 Deborah Roth Ledley, David M. Fresco, 12 Cognitive Vulnerability to Anxiety Disorders

NOC Anxiety Control

Assess anxiety level, fears and concerns, ability to express needs, and how anxiety is manifested. Ask clients to rank their anxiety as mild, moderate, severe, or incapacitating. Assist child and family to identify at least two coping mechanisms to use for coping with anxiety (specify suggestions such as music, exercise, talking to spiritual advisor, use of humor). interventions to relieve anxiety and increased comfort. improved or worsening levels of anxiety. Coping mechanisms help relieve the stress of anxiety. Humor is not always out of place and may be helpful to diffuse tension if judiciously used. Provides opportunity to vent feelings and fears to reduce anxiety.

Generalized Anxiety Disorder

GAD has a lifetime prevalence of approximately 5 3 with more than 90 of individuals having at least one other comorbid psychiatric disorder including depression or another anxiety disorder.3 GAD is second to only depression as the most frequent psychiatric disorder in the primary care setting. DSM IV-TR2 characterizes GAD as excessive anxiety and apprehension occurring more days than not, over at least a 6 month period. The anxiety and apprehension are accompanied by somatic symptoms such as restlessness, disturbed sleep, difficulty concentrating, and muscle tension. These symptoms, taken together, are also associated with a significant subjective distress and impairment in both social and work functioning. GAD tends to be a chronic and recurrent disease with less than one-half of cases remitting without medical treatment. Approximately 48 of GAD patients seek professional help with 25 of these patients receiving medication for the disorder.

Social Anxiety Disorder

SAD or social phobia is a common anxiety disorder often associated with serious role impairment. The 12-month prevalence rate for all types of SAD was estimated to be 8 with a lifetime prevalence of 13 . SAD is a chronic disease with a slightly higher prevalence in females than males (15 versus 11 , respectively), with retrospective studies showing an average duration of 25 years. Overall, females with poor baseline functioning at the time of diagnosis have the greatest risk of disease chronicity. DSM IV-TR defines SAD as a marked and persistent fear of social or performance situations in which embarrassment may occur. The diagnosis of SAD is only made when the fear, avoidance, or anxious anticipation of the event persists for at least 6 months and the phobia directly interferes with daily function or when the individual is distressed about having the phobia. Although SAD can relate to a specific set of circumstances (i.e., public speaking), there are cases in which there can be a...

Genetic Basis of Anxiety

Both human and animal studies have provided evidence for a genetic influence in the etiology of anxiety. A growing number of genetically altered mice have been produced in an effort to identify specific genes conferring enhanced or reduced risk for anxiety disorders. A meta-analysis of family studies, as well as twin studies and prospective studies in children of anxious parents, have demonstrated a significant familial aggregation for all anxiety disorders. From these studies, the range of reported genetic effect has been 25-65 . It has also been postulated that anxiety disorders may represent a complex genetic trait in which genetic risk factors are probabilistic rather than deterministic in nature.21 The development of knockout and transgenic mice has facilitated investigations into the contribution of several classes of neurotransmitters receptors to anxiety.

Obsessive Compulsive Disorder

Double-blind, placebo-controlled multicenter trials are required to establish efficacy in OCD and require exclusion of patients with comorbid conditions of marked severity, including anxiety, depression, mixed schizoid, and schizotypal disorders. The Y-BOCS (Yale-Brown obsessive compulsive scale), a 10 item, clinician-administered scale, is the most

A role for CRF in anxietyrelated disorders

Whilst there is considerable data on the role of CRF in depression,89 CRF systems may also play a role in anxiety states. CRF has central, behavioral arousal properties characteristic of other anxiogenic compounds that relate directly to the hyperarousal that defines anxiety disorders. CRF has been implicated as a mediator in panic disorder based on the observation that patients with this disorder exhibit a blunted ACTH response to CRF as compared to normal individuals. This blunted response likely reflects processes occurring above the level of the hypothalamus related to hypersecretion of CRF. In rats, CRF disrupts PPI in a manner similar to that observed in patients with panic disorder where the CRF system is thought to be overactive.97 These effects could be reversed by CRF receptor antagonists.89

Potential CRF receptor antagonists for anxiety

As CRF appears to plays a major role in the regulation of stress responses and the subsequent anxiety a concerted effort has focused on the search for orally active, nonpeptide antagonists. Examples of the different compound classes with high affinity for the CRF1 receptor are shown in Figure 9.98 Interestingly, while these molecules are chemically distinct, they appear to fit a common pharmacophore indicating that the receptor has strict requirements to allow a high-affinity interaction.98

Benzodiazepine site ligands

Required to produce functional GABAA receptors that exhibit all the pharmacological properties of native GABAA receptors. The diversity of subunits and their heterogeneous distribution between brain regions raises the question of whether GABAA receptors composed of different subunit combinations play different functional roles in the brain. GABAa receptors containing a1, a2, a3, or a5 subunits in combination with b,g subunits bind to and are potentiated by BZs. In contrast, a4- or a6-subunit-containing receptors are insensitive to classical BZs like diazepam (exceptions being the BZ antagonist, Ro15-1788 and the inverse agonist, Ro 15-4513, which show weaker activity at a4 and a6). Differences in BZ ligand affinity between a subunits results from a histidine (His 101 in rat a1) at the homologous position in a1, a2, a3, and a5, while an arginine is present in the homologous position in the a4 and a6 subunits. Transgenic mouse lines with a single histidine (H) to arginine (R) mutation...

Benzodiazepine site ligands with partial efficacy

The imidazobenzodiazepines bretazenil, imidazenil, and FG-8205 (Figure 10a) are high-affinity partial agonists for GABAA receptor subtypes that contain a1, a2, a3, and a5 subunits. These compounds are anxiolytic in animal models, with a greater separation between doses required for anxiolytic versus sedative effects than that observed for diazepam. Where studied, these compounds also show little evidence for tolerance to the anxiolytic effects, do not display withdrawal, and have a lower abuse potential than full BZ agonists in nonhuman primates. Bretazenil (Figure 10a) entered clinical studies in the mid-1980s and was efficacious in GAD and panic disorder,112 with a lower abuse potential than diazepam.113 However, bretazenil was sedative, with little evidence for separation between anxiolytic and sedative effects,114 and its clinical development was discontinued. The b-carboline abecarnil (Figure 10a), has high affinity for a1-, a2-, a3-, and a5-subunit-containing GABAA receptors,...

GABAa subtypeselective benzodiazepine site ligands

No NCEs have yet been reported with a high degree of selective affinity for GABAA receptor subtypes believed to be important for anxiolysis. However, compounds have been identified that, despite having similar affinities, show a degree of functional selectivity for different a-subunit-containing GABAA receptors (i.e., they behave as full or partial modulators of certain subtypes and neutral modulators of others). A compound preferentially potentiating a2-subunit-containing GABAA receptor responses could provide anxiolytic effects with a separation from sedation and memory impairment. A pyridine-2-one derivative, which behaves as a negative allosteric modulator with functional selectivity for a3-subunit-containing GABAA receptors, increased anxiety responses in rodents82'118 suggesting that potentiation of a3-subunit-containing GABAA receptor responses may also provide anxiolysis. The triazalopyradizine, L-838417 (Figure 10b), had high affinity for a1-, a2-, a3-, and...

NIC Anxiety Reduction

Reduces anxiety of parents. child and assists in reducing parental anxiety. Reduces anxiety caused by fear of the unknown. Prevents increase of anxiety which increases respiratory distress. Reduces child's anxiety and avoids precipitating a complete obstruction. Reduces anxiety and embarrassment. positive outcome and reduces anxiety.

Alcohol Induced Anxiety Affective or Psychotic Disorder

If symptoms of an anxiety disorder, affective disorder (depressive, manic, or mixed), or psychotic disorder (hallucinations or delusions) develop during or within 1 month of intoxication or withdrawal, an alcohol-induced anxiety, affective, or psychotic disorder may be diagnosed. If the patient has insight that hallucinations are alcohol-induced, an alcohol-induced psychotic disorder is not diagnosed. The anxiety and affective symptoms must exceed the usual presentation of such symptoms as they commonly occur during intoxication or withdrawal (DSM-IV).

Mood And Anxiety Disorders

The results of recent twin studies of mood and anxiety disorder symptoms across the life span suggest some differences in the etiology of these symptoms in childhood versus adulthood. Only a few twin studies hav been conducted with children and adolescents, so we will begin with a review of the more extensive adult findings. In the final section of the chapter, we discuss the potential theoretical implications of discrepancies between the child and adult findings concerning mood and anxiety disorder symptoms in terms of genotype-environment correlation. In this section, we will review univariate findings (concerning the etiology of a single symptom dimension) before discussing multivariate findings (concerning common etiological influences acting on two or more different symptom dimensions) for mood and anxiety disorders.

Multivariate Behavior Genetic Studies of Mood and Anxiety Disorder Symptoms

Most multivariate behavior genetic contributions to the classification of mood and anxiety disorders have been based on three general approaches (1) split an existing diagnostic category into subtypes and examine differences in the causes of the resulting subtypes (2) look for common causes that cut across the symptoms of several diagnostic categories, using multivariate behavior genetic methods or (3) combine the first two approaches (i.e., break down a given diagnostic category into clusters of symptoms and then examine their common causes) to determine whether the etiologies of various symptom clusters may be partially overlapping and partially independent. study by Kendler et al. (1996 see earlier), who reported that genetic and environmental influences on various subtypes of depressive illness appeared to have different etiologies. Research with adults suggests that genes may act in a nonspecific way to confer risk for a variety of mood and anxiety syndromes, and the particular...

Benzodiazepine Dependence

Benzodiazepine Biotransformation

Prolonged regular use of benzodiaze-pines can lead to physical dependence. With the long-acting substances marketed initially, this problem was less obvious in comparison with other dependence-producing drugs because of the delayed appearance of withdrawal symptoms. The severity of the abstinence syndrome is inversely related to the elimination t1 2, ranging from mild to moderate (restlessness, irritability, sensitivity to sound and light, insomnia, and tremulousness) to dramatic (depression, panic, delirium, grand mal seizures). Some of these symptoms pose diagnostic difficulties, being indistinguishable from the ones originally treated. Administration of a benzodiazepine antagonist would abruptly provoke abstinence signs. There are indications that substances with intermediate elimination half-lives are most frequently abused (violet area in B). A. Biotransformation of benzodiazepines A. Biotransformation of benzodiazepines

Anxiety Management Skills

It can be useful to provide anxiety management strategies early in therapy because (1) they can give patients a degree of control over their distress, and (2) these techniques are relatively simple to use. Be aware that most patients experience considerable distress during the initial sessions because they are confronting and expressing upsetting memories. The utility of reducing arousal in the acute posttrauma phase is also indicated by evidence that acute arousal is associated with chronic PTSD (Shalev et al., 1998). Giving the patient some tools to assist mastery over the acute anxiety can provide both a sense of relief and a motivation to comply with more demanding therapy tasks. Anxiety management often involves progressive muscle relaxation (Ost, 1987) and breathing retraining, which aims to achieve 10 breaths a minute. Although these techniques are simple, therapists need to be aware that focusing on bodily sensation or on breathing can trigger reminders of the trauma. First,...

NIC Anxiety Reduction Evaluation

Feelings, secure information needed to reduce anxiety. Reduces anxiety caused by fear of unknown. Prevents overwhelming child and parents with information in small amount of time as diagnosis and procedures usually carried out within a short period of time and anxiety will prevent ability to comprehend. Reduces anxiety when knowledge and support is given and child and parents will not feel betrayed by inadequate preparation of procedures and treatments. (Did parents report decreased anxiety Use quotes.) (Revisions to care plan D C care plan Continue care plan )

Pharmacokinetics of Benzodiazepines

All benzodiazepines exert their actions at specific receptors (p. 226). The choice between different agents is dictated by their speed, intensity, and duration of action. These, in turn, reflect physico-chemical and pharmacokinetic properties. Individual benzodiazepines remain in the body for very different lengths of time and are chiefly eliminated through biotransformation. Inactivation may entail a single chemical reaction or several steps (e.g., diazepam) before an inactive metabolite suitable for renal elimination is formed. Since the intermediary products may, in part, be pharmacologically active and, in part, be excreted more slowly than the parent substance, metabolites will accumulate with continued regular dosing and contribute significantly to the final effect. The range of elimination half-lives for different benzodiazepines or their active metabolites is represented by the shaded areas (B). Substances with a short half-life that are not converted to active metabolites can...

Anxiety Through The Course Of Hiv And Aids

Persons with HIV and AIDS may experience anxiety from the first realization of being at risk to the existential anxiety that may accompany inexorable progression of illness near the end of life. Pathologic anxiety is differentiated from normal fear response in that it is out of proportion with respect to the environmental stimulus in question, has significant intensity and duration, and results in either impairment of coping, disruption of normal function, or abnormal behaviors (Pollack et al., 2004). The determinants of severity of anxiety are multifactorial and are related to social support and experience with prior stressors and illnesses, as well as coping capacity, defensive structure, adaptive capacity, resilience, and the presence or absence of other psychiatric disorders. In addition to the psychological and social factors, severity and presence of comorbid medical conditions play a significant role in the level of anxiety experienced.

Psychoimmunology Of Anxiety In Hiv Infection

The role of neuroendocrine pathways, namely the hypothalamic-pituitary-adrenal axis and the sympathetic adrenomedullary system, in anxiety disorders is only partially understood. To date, studies do not agree on the relationship between immune function and psychological distress in persons with HIV and AIDS (Antoni et al., 1991 Sahs et al., 1994 Kimmerling et al., 1999 Sewell et al., 2000 Antoni, 2003 Dela-hanty et al., 2004). One challenge of such studies is that the physiologic effects of HIV must be distinguished from those attributed to anxiety. For further details regarding the interaction between HIV, psychiatric illness, and the immune system, please refer to Chapter 3.

Competing Conceptualizations of Anxiety

In a number of papers published in the 1970s, Gray (e.g., 1976, 1978, 1979) proposed a ''neuropsychological theory of anxiety'' that draws on the motivational constructs described before. This early work can best be viewed as an attempt to understand, in terms of the constructs of learning theory, the common behavioral effects of those pharmacological agents that clinically reduce anxiety. Among these are alcohol, barbiturates, and minor tranquilizers. Gray (1977) reviewed the extensive literature on the behavioral effects of antianxiety drugs, and he (1979) summarized the conclusions from that review. The studies reviewed pointed to reduced effectiveness of the BIS in inhibiting behavior in response to PUN-CSs and nonREW-CSs. With respect to the paradigms described before, the antianxiety drugs disinhibit behavior in the passive-avoidance situation, and they increase resistance to extinction following continuous reinforcement. Rates of response are also reliably increased under...

Neurochemical Basis of Anxiety

Neurochemical modulators exist at every level within the complex neurocircuitry described above, providing a large number of potential therapeutic targets for the treatment of anxiety. Despite the variations in clinical presentation of the various anxiety disorders, extensive preclinical studies have provided significant evidence for the role of multiple neurochemical systems in the etiology of anxiety, in general, with a significant amount of overlap between the individual disorders themselves. The major neuromodulators and neuromodulatory systems that have been implicated both through preclinical and clinical studies include the monoamines (5-hydroxytryptamine (5HT), norepinephrine (NE), and dopamine), corticotrophin-releasing factor (CRF), g-amino-butyric acid (GABA), glutamate, neuropeptides (substance P, neuropeptide Y galanin), cholecystokinin, and neurotrophic factors.20

Additional Nursing Diagnoses Anxiety

Goal Client will experience decreased anxiety by (date time to evaluate). V (Specify, e.g., display relaxed facial features, engage in relaxation exercises, express feeling in control of anxiety.) NOC Anxiety Control Assess level and manifestations of anxiety in parents and child at each visit. Provides information needed for interventions and clues to severity of anxiety. feelings and secure information to reduce anxiety. Promotes trust and reduces anxiety. Relieves anxiety caused by fear of the unknown. Reduces anxiety by allowing presence and involvement in care and provides familiar persons and routine for child. reduces anxiety about whether child is improving. anxiety caused by inaccurate information or beliefs. Provides information of what might be expected and what to report in order to allay anxiety. NIC Anxiety Reduction Evaluation (Did parent child verbalize decreased anxiety Describe facial tension did parent child do relaxation exercises What did parent child say about...

Sedative Hypnotic or Anxiolytic Induced Disorders

Dependence Abuse Intoxication Withdrawal Intoxication delirium Withdrawal delirium Induced persistent amnesic disorder Induced psychotic disorders With delusions With hallucinations Induced mood disorder Induced anxiety disorder Induced sexual disorder Induced sleep disorder

Sedatives Hypnotics and Benzodiazepines

The sedatives and the hypnotics, especially the benzodiazepines, are widely used in medical practice in the treatment of anxiety, insomnia, epilepsy, and for several other indications (Baldessarini, 2001). The combination of abuse by alcoholics and drug addicts, and the withdrawal symptoms on discontinuation leads to the view that these are addictive drugs (DuPont, 2000 Juergens & Cowley, 2003). The pharmacology and the epidemiology of sedatives and hypnotics are reviewed in this chapter, which focuses on the needs of the clinician. The benzodiazepines resemble the other sedatives, except that they do not produce surgical anesthesia, coma, or death, even at high doses, except when coadministered with other agents that suppress respiration. The benzodiazepines can be antagonized by specific agents that do not block the effects of other sedatives. The benzodiazepine antagonists do not produce significant effects in the absence of the benzodiazepines. These properties distinguish the...

Univariate Studies of Mood and Anxiety Disorder Symptoms

Kendler, Heath, Martin, & Eaves (1986) examined the causes of individual differences in anxiety and depressive symptoms in adults recruited from a large, nationwide twin registry in Australia. Symptoms of anxiety and depression were assessed by using a self-report questionnaire, the Delusions-Symptoms-States Inventory (DSSI). The authors found that a model including only genetic and nonshared environmental influences provided a satisfactory fit to the observed data, and the heritability for most symptoms ranged from .33 to .46. Several studies have been based on assessments of DSM-III, DSM-III-R, or DSM-IV affective disorders. In a sample of adult female twins recruited from a large population-based twin registry in Virginia, Kendler and colleagues (1992b) found that liability to major depression was moderately heritable (h2 .20 to .45), and the remainder of the variance in liability was once again attributable to nonshared environmental influences. The authors later...

Discontinuation of Benzodiazepine

Discontinuation of sedatives and hypnotics, including the benzodiazepines, can be divided into three categories (1) long-term low-dose benzodiazepine use, (2) high-dose benzodiazepine abuse and multiple drug abuse, and (3) high-dose abuse of nonbenzodiazepine sedatives and hypnotics (especially intermediate-acting barbiturates). The first group of patients can usually be discontinued on an outpatient basis. Some of the second and even the third group can be treated as outpatients, but most will require inpatient care. Inpatient discontinuation today with managed care is generally reserved for patients who fail at outpatient discontinuation and for those who demonstrate acutely life-threatening loss of control over their drug use. The pharmacological management of inpatient benzodiazepine withdrawal from nontherapeutically high doses of these medicines is covered in standard texts dealing with inpatient detoxification (Wesson et al., 2003). With respect to withdrawal from...

Identification Of Problems Among Longterm Benzodiazepine Users

Physicians frequently encounter patients, or family members of patients, who are concerned about the possible adverse effects of long-term use of a benzo-diazepine in the treatment of anxiety or insomnia. In helping to structure the decision making for such a patient, we use the Benzodiazepine Checklist (DuPont, 1986 see Table 10.2). There are four questions to be answered 1. Diagnosis. Is there a current diagnosis that warrants the prolonged use of a prescription medicine The benzodiazepines are serious medicines that should only be used for serious illnesses. 2. Medical and nonmedical substance use. Is the benzodiazepine dose the patient is taking reasonable Is the clinical response to the benzodiazepine favorable Is there any use of nonmedical drugs, such as cocaine or marijuana Is there any excessive use of alcohol (e.g., a total of more than four drinks a week, or more than two drinks a day) Are other medicines being used that can depress CNS functioning 4. Family monitor. Does...

Application to Anxiety Disorders

In an interesting extrapolation to psychopathol-ogy, McNaughton and Gray attribute GAD to excessive output from the SHS. Underscoring the information processing aspects of the SHS, they describe GAD as primarily a cognitive disorder that involves an excessive perception of threat and a subsequent suppression of approach and excessive avoidance of threat. In contrast, the fight flight system (which has a greater involvement of the amygdala fear system) mediates panic attacks (Gray, 1987, p. 366). Gray's BIS theory readily accounts for the association between anxiety, on the one hand, and such characteristics as shyness, social withdrawal, sensitivity to punishments, a tendency to be easily discouraged, and a failure to develop active means of coping with situations, on the other hand a dimension of internalizing disorders identified in multivariate studies of children (Achenbach & McConaughy, 1997 Quay, 1986). These are the characteristics to be expected in an individual in whom the...

Distinguishing Medical And Nonmedical Use Of Benzodiazepines

A series of national surveys tracking the medical use of the benzodiazepines showed that their use peaked in 1976 and by the late 1980s had fallen about 25 off that peak rate (DuPont, 1988). A 1979 survey of medical use of the benzodiazepines (near the peak of benzodiazepine use in the United States), showed that 89 of Americans ages 18 years and older had not used a benzodiazepine within the previous 12 months. Of those who had used a benzodiazepine, most (9.5 of all adults) had used the benzodiazepine either less than every day or for less than 12 months, or both, whereas a minority (1.6 of the adult population) had used a benzodiazepine on a daily basis for 12 months or longer. This long-term user group was two-thirds female 71 were age 50 or older, and most had chronic medical problems, as well as anxiety (DuPont, 1988). Of those with anxiety disorders in a large community sample, three-fourths were receiving no treatment at all, including not using a benzodiazepine. The 1.6 of...

Anxiety

Anxiety disorders (see 6.04 Anxiety) are characterized by an abnormal or inappropriate wariness. There are several disorders that fall under the heading of anxiety including panic disorders, phobias, generalized anxiety disorder (GAD), acute stress disorder, and posttraumatic stress disorder (PTSD). Panic disorder is characterized by rapid and unpredictable attacks of intense anxiety that are often without an obvious trigger. Phobias are examples of life-disrupting anxiety or fear associated with an object or situation, including social phobias. GAD develops over time and involves the generalization of fears and anxieties to other, usually inappropriate situations until they ultimately result in an overwhelming anxiety regarding life in general. Acute stress disorder involves the response to a threatened or actual injury or death and is characterized by dissociation, detachment, and depersonalization. Acute stress disorder usually resolves within a few weeks however it can progress...

Benzodiazepines

The origin of BZs stemmed from the 'diversity oriented,'81 search for a new tranquilizer. Chlordiazepoxide was synthesized in 1955 but was not evaluated in vivo until 3 years later when it was found to be a potent CNS depressant. The reason for not subjecting chlordiazepoxide to biological evaluation earlier was the fact that the compound was thought to be quinazoline-N-oxide 1, which resulted from the failed synthesis of heptoxdiazine 2 (Figure 2a). Several analogs of 1 were subjected to in vivo evaluation and all failed to show the desired effect. The attempted synthesis of 2 was performed simply because the compounds would be diverse relative to the known tranquilizers of the day

Clonazepam

kloh-NAY-zeh-pam Alti-Clonazepam M, Apo-Clonazepam M, Dom-Clonazepam M, Klonopin, Nu-Clonazepam M, PMS-Clonazepam M, Rivotril M C-IV Rx See also Anticonvulsants. Action Kinetics Benzodiazepine derivative which increases presyn-aptic inhibition and suppresses the spread of seizure activity. Peak plasma levels 1-2 hr. tv2 18-60 hr. Therapeutic serum levels 20-80 ng mL. More than 80 bound to plasma protein metabolized almost completely in the liver to inactive metabolites, which are excreted in the urine. Even though a benzodiazepine, clonazepam, is used only as an anti-convulsant. However, contraindications, side effects, and so forth are similar to those for diazepam. Uses Absence seizures (petit mal) including Lennox-Gastaut syndrome, akinetic and myoclonic seizures. Some effectiveness in clients resistant to succinimide therapy. Non-FDA Approved Uses Parkinsonian dysarthria, acute manic episodes of bipolar affective disorder, leg movements (periodic) during sleep, adjunct in...

Extreme Anxiety

Some individuals present with very extreme anxiety that often may reflect pretrauma anxiety states. Moreover, many people present with panic attacks following trauma (Nixon & Bryant, 2003). Employing exposure therapy with these individuals in the acute phase can compound their anxiety state and their posttraumatic difficulties. Instead, these individuals may require containment, support, and anxiety reduction strategies. Some individuals benefit from techniques that limit panic attacks, including interoceptive exposure and cognitive restructuring (Craske & Barlow, 1993). Many people in the acute phase also require assistance in learning how to tolerate distress and in developing skills in reducing their anxiety states (see Cloitre & Rosenberg, Chapter 13, this volume).

Diazepam Valium

Diazepam (DZP) is a benzodiazepine (BDZ) with central nervous system (CNS)-depressant properties. It has anxiolytic, sedative hypnotic, muscle relaxant, and anticonvulsant effects. DZP is used in humans for the short-term relief of symptoms related to anxiety disorders the treatment of agitation, tremors, delirium, seizures, and hallucinations as a result of alcohol withdrawal the relief of muscle spasms in certain neurological diseases and the control of active seizures (Costa and Guidotti 1979). GABA, the predominant inhibitory neurotransmitter in the brain, affects the activation of GABA receptors, which are ligand-gated chloride ion channels that mediate inhibitory synaptic transmission in the vertebrate CNS. BDZs potentiate GABA-mediated inhibition via the GABAa receptor in the CNS (Morrow 1995). In addition, the peripheral BDZ receptor (PBR) is expressed by several fetal and adult tissues and cells (Burgi et al. 1999 Krueger 1991). DZP has equal affinities for both central and...

Social Cost and Market

The pervasiveness of psychiatric disorders, e.g., depression, substance abuse, anxiety, schizophrenia, etc., and the comorbidity of depression and anxiety with neurological disease has enormous costs for society, estimated in the trillions of dollars. Additionally, it has been estimated that over 60 of individuals with diagnosable mental disorders do not seek treatment.

Central Nervous System Disorders Psychiatric and Neurodegenerative

Disorders of the CNS are broadly categorized as either psychiatric or neurodegenerative with a major degree of overlap in symptoms. Thus neurodegenerative disorders also have a high incidence of psychiatric comorbities including anxiety and depression. Psychiatric disease includes a variety of disorders such as schizophrenia, depression, obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), and others. The underlying pathology is usually considered to be the result of synaptic dysfunction driven by (1) a dysregulation of neurotransmitter availability or (2) signaling, the latter at the receptor and or signal transduction levels. The net result is an alteration in neuronal circuitry involving multiple neurotransmitter neuromodulator systems.

Genetic Considerations

In most cases, the patient with an AAA faces hospitalization, a serious surgical procedure, a stay in an intensive care unit, and a substantial recovery period. Therefore, assess the patient's coping mechanisms and existing support system. Assess the patient's anxiety level regarding surgery and the recovery process.

How To Use Delmars Dental Drug Reference

Client Family Teaching Specific information for the client is provided for each drug. Client family teaching emphasizes specifics to help the client family recognize side effects, avoid potentially dangerous situations, and to alleviate anxiety that may result from taking a particular drug. Side effects that require medical intervention are included as well as specifics on how to minimize side effects for certain medications (i.e., take medication with food to decrease GI upset or take at bedtime to minimize daytime sedative effects). The scope of drugs covered in this reference includes traditional dental drugs used in the treatment of perio-dontal disease, antibiotic prophylaxis, and pain management with amide local anesthetics, NSAIDs, and opioid analgesics. Also, coverage is provided for other dental related drugs that are given systemically for the treatment of anxiety and other general infections. Coverage also includes cardiovascular drugs, opi-oid analgesics, opioid...

Tools For Traumarelated Problems

Central to approaches that focus on reduction of posttraumatic fear reactions is exposure therapy. Prolonged Exposure (PE) treatment is the most well-validated psychosocial treatment for PTSD. As described by Riggs, Cahill, and Foa in Chapter Four, it focuses on reducing trauma-related anxiety by encouraging the client to confront situations, activities, thoughts, and memories that are feared and avoided but that are not inherently dangerous. Treatment incorporates four primary procedures education about trauma and PTSD, breathing retraining, in vivo or real-world exposure to feared but safe trauma-related situations that the client normally avoids, and imaginal exposure in which the client repeatedly describes memories of the traumatic event.

Stroke and nervous system trauma

Enhancers of GABAergic transmission (e.g., BZs, tiagabine), t-type calcium channel blockers (ethosuximide), and compounds that posses either multiple or unknown mechanisms of action (e.g., valproate, gabapentin, lamotrigine, topiramate). For the most part these compounds are prescribed on the basis of type of seizure and on previous data demonstrating efficacy. For example, partial seizures may be treated with lamotrigine or carbamazepine as a front-line therapy, with the addition of tiagabine or gabapentin as an adjunct if needed. A similar front-line approach is taken for generalized tonic-clonic seizure however, second-line treatment would include phenytoin or clonazepam. Ethosuximide is a common choice for treating absence seizure with clonazepam or topiramate used as a second-line therapy.

Discharge And Home Healthcare Guidelines

Respiratory acidosis is a pH imbalance that results from alveolar hypoventilation and an accumulation of carbon dioxide. It can be classified as either acute or chronic. Acute respiratory acidosis is associated with a sudden failure in ventilation. Chronic respiratory acidosis is seen in patients with chronic pulmonary disease, in whom long-term hypoventilation results in a chronic elevation (> 45 mm Hg) of PaCO2 levels (hypercapnia), which renders the primary mechanism of inspiration, an elevated PaCO2, unreliable. The major drive for respiration in chronic pulmonary disease patients becomes a low oxygen level (hypoxemia). Respiratory alkalosis is a pH imbalance that results from the excessive loss of carbon dioxide through hyperventilation (PaCO2 < 35 mm Hg). Respiratory alkalosis is the most frequently occurring acid-base imbalance of hospitalized patients. Improper use of mechanical ventilators can cause iatrogenic respiratory alkalosis, whereas secondary respiratory alkalosis...

How much information should be disclosed

The amount of information given to patients as part of the randomization and consent process varies greatly. The level of verbal information is often decided by doctors on an individual and sometimes ad hoc basis. Whilst some clinicians believe that only total disclosure of all information is ethical, others suggest that information overload can distress the patient unduly. An Australian randomized study, which compared two methods of seeking consent (an individual approach at the discretion of the doctor versus total disclosure) for entry to trials of different standard cancer treatments, found that patients who experienced total disclosure were less willing to enter the trial and were significantly more anxious 22 . A more recent randomized study comparing standard consent methods with the same plus a follow up telephone call from an oncology nurse found that the latter resulted in the patients being better informed about the trial and their treatment. It did not significantly...

The yAmino Butyric Acid GABA Hypothesis

G-Amino-butyric acid (GABA) is the major inhibitory transmitter in the CNS, and has many effects that are opposite to those of glutamate, some of which involve GABAergic inhibition of glutamate function. The GABA uptake inhibitor, CI-966 9, has been associated with psychotic episodes in humans,17 a similar phenotype to that seen with the psychotomimetics that block the effects of glutamate at the NMDA receptor. A role of GABA in the etiology of schizophrenia was first proposed in the early 1970s based on GABAergic regulation of DA neuronal function with a special focus on the role of GABA in working memory. GABA uptake sites are decreased in hippocampus, amygdala, and left temporal cortex in schizophrenics with some evidence of GABAa receptor upregulation18 and reductions in GABA interneurons.19 An extensive review of the use of benzodiazepines, the classical GABAA agonists, the GABAg agonist

Primary Nursing Diagnosis

Body image disturbance related to anxiety over thickened skin and enlargement of face, hands, and feet OUTCOMES. Self-esteem Body image Anxiety control INTERVENTIONS. Body image enhancement Coping enhancement Emotional support Self-esteem enhancement Support group Anxiety reduction

Psychiatric Disorders 601411 Schizophrenia

Sedative, hypnotic, or anxiolytic related disorders Sedative, hypnotic, or anxiolytic use disorders Sedative, hypnotic, or anxiolytic induced disorders Anxiety disorders Panic disorder without agoraphobia Panic disorder with agoraphobia Social phobia Obsessive compulsive disorder Generalized anxiety disorder

Privileged Organic Scaffolds

Privileged organic scaffolds249 include, for instance, the benzodiazepine scaffolds (Figure 21) that have been utilized by Evans et al.246 Benzodiazepine scaffolds are thought to mimic a reverse turn,250 and their analogs continue to generate leads against multiple peptide receptors.251-254 Further, Haskell-Luevano et al.255 screened a library of 951

First Generation Typical Antipsychotic Drugs

The serendipitous finding in 1951 that the major tranquilizer, chlorpromazine 1, was effective in treating delusions and hallucinations associated with schizophrenia and other psychotic disorders marks the beginning of modern therapy for schizophrenia.3 Unfortunately, treatment with chlorpromazine was accompanied by the development of EPS, some appearing even after the first dose (e.g., dystonias, akathisia). Other adverse effects were delayed for days or weeks such as parkinsonism, and the sometimes fatal neuroleptic malignant syndrome. Tardive dyskinesia, characterized by abnormal involuntary movements of the tongue, facial muscles, or limb muscles, develops in about 20 of patients and may be irreversible. Chlorpromazine also increased prolactin secretion leading to gynecomastia, galactorrhea, menstrual irregularities, sexual dysfunction, and possibly bone loss over the long term. Sedation, hypotension, and weight gain were also common with chlorpromazine. Despite these concerns,...

Second Generation Atypical Antipsychotic Drugs

The discovery of the benzodiazepine, clozapine 12, in 1959 ushered in a new generation of potentially superior antipsychotic drugs. Clozapine was able to block DA-mediated behavior in animals and exerted antipsychotic effects in humans at doses that did not elicit EPS or produce sustained elevations in serum prolactin levels in humans. The motor symptom profile was sufficiently different from the first-generation antipsychotic drugs such that clozapine was labeled 'atypical' and clozapine became the blueprint for the development of other atypical antipsychotic drugs. Based on this blueprint, close clozapine analogs were developed that include loxapine 45, olanzapine 49, quetiapine 46, and asenapine 50, while the structurally dissimilar benzisoxidil group including risperidone 47, iloperidone 51, and ziprasidone 48, and the phenylindole derivative, sertindole 52.

Anticipated Challenges And Achievements

Another important classification consideration on the horizon is whether or not acute stress disorder (ASD) and PTSD should be classified as anxiety disorders. Evidence supporting abandonment of the anxiety disorder placement indicates that a myriad of emotions, including guilt, shame, disgust, anger, and sadness, have been implicated in preventing recovery from posttraumatic symptoms (Resick, 2001). Moreover, Pitman (1993) has argued that the pathophysiology of arousal in posttraumatic reaction is not simply anxiety. The International Statistical Classification of Diseases, Injury, and Causes of Death-10th Edition (ICD-10 World Health Organization WHO , 1992) does not classify PTSD as an anxiety disorder rather, it is categorized within the spectrum of reactions to severe stress, and adjustment disorders, with the common denominator of stress-related precipitation. A recent taxometric study also buttresses the dimensional versus categorical system of trauma-related diagnoses (Ruscio,...

Functional Analytic Clinical Assessment in Trauma Treatment

Since the establishment of the diagnosis of PTSD in the DSM-III and subsequent updates (American Psychiatric Association, 1980, 1987, 1994, 2000), a considerable volume of literature has been published that describes clinical problems that may be likely to co-occur with PTSD. At the level of diagnostic labels, PTSD is noted to co-occur with depression, anxiety, phobia, and panic disorders perhaps in part because of symptom overlap in diagnostic criteria (Davidson & Foa, 1991). A variety of other diagnostic labels are also associated with PTSD, including substance abuse and Axis II cluster B disorders, such as borderline personality disorders with impulsivity (Foa, Davidson, Frances, & Anxiety Disorders Association of America, 1999). Treatment guidelines include cognitive therapy to address unrealistic assumptions, thoughts, and beliefs anxiety management and stress inoculation techniques, including relaxation training and imaginal or in vivo expo

Historical and Social Context of Psychoactive Substance Use Disorders

Psychoactive substances subserve several human functions that can enhance both individual and social existence. On the individual level, desirable ends include the following relief of adverse mental and emotional states (e.g., anticipatory anxiety before battle and social phobia at a party), relief of physical symptoms (e.g., pain and diarrhea), stimulation to function despite fatigue or boredom, and time-out from day-to-day existence through altered states of consciousness. Socially, alcohol and drugs are used in numerous rituals and ceremonies, from alcohol in Jewish Passover rites and the Roman Catholic Mass, to peyote in the Native American Church and the serving of opium at certain Hindu marriages. To a certain extent, the history of human civilization parallels the development of psychoactive substances (Westermeyer, 1999).

Functional Analytic Clinical Assessment The Purpose of Functional Analysis

The last criterion Haynes and O'Brien suggest is to identify causal variables. Causal in this context is not so much a notion of ultimate causality as a reference to those variables that, when changed, reliably precede and produce change in the targeted clinical problem. If the therapist can identify unique functional relationships that ameliorate specific individual problems for individual patients, then the therapist will also observe additional treatment effects to those derived by administering a protocol-driven treatment plan that is designed for the hypothetical average patient. For example, for a rape victim, a sexual encounter with a new romanitic partner may seemingly cause anxiety and distress. In fact, it is not the current romantic encouter that is the ultimate cause of symptoms the rape is. However, from a clinical standpoint, the current sexual stimuli such as touch, smells, and arousal can serve as cues for when and what desensitization strategies should be applied.

Client Family Teaching

Several antihypertensive agents cause sedation which can be intensified with the addition of an opioid analgesic or benzodiazepine. Use caution when doing anything that requires thought or concentration, such as operating heavy machinery, driving a car, or taking care of children.

Asian Proprietary Medicine or Asian Patent Medicine

Several studies of the chemical composition of these preparations have found that they frequently contain potentially toxic ingredients. Recent data indicate that approximately one-third of these products contain drugs or dangerous metals. Drugs that have been found include diazepam (Valium), steroids, and prescription asthma medications. Toxic metals sometimes found in these products are arsenic, mercury, lead, and cadmium.

Dopamine transporter polymorphisms

DAT terminates dopaminergic neurotransmission by reuptake of dopamine (DA) in presynaptic neurons and plays a key role in DA recycling. DAT can also provide reverse transport of DA under certain circumstances. Psychostimulants such as cocaine and amphetamines and drugs used for attention deficit hyperactivity disorder (ADHD) such as methylphenidate exert their actions via DAT Altered DAT function or density has been implicated in various types of psychopathology, including depression, BPAD, suicide, anxiety, aggression, and schizophrenia. Altered transport properties associated with some of the coding variants of DAT suggest that individuals with these DAT variants could display an altered DA system.17'20 Multiple human dopamine transporter (hDAT, SLC6A3) coding variants have been described, though to date they have been incompletely characterized. The antidepressant, bupropion (6) dose-dependently increases vesicular DA uptake an effect also associated with VMAT-2 protein...

Serotonin transporter polymorphisms

Reduced binding of imipramine and paroxetine to brain and platelet SERTs in patients with depression and suicide victims indicates that altered SERT function might contribute to aberrant behaviors. Two polymorphic regions have been identified in the SERT promoter and implicated in anxiety, mood disorders, alcohol abuse, and in various neuropsychiatric disorders.21 Thus, studies are emerging to support the notion that impaired regulation might contribute to human disease conditions such as those seen in human variants of the SERT coding region.

Drug Interactions

Antianxiety drugs See Alcohol Anticholinergic drugs Additive anticholinergic side effects and or l antipsychotic effect Antidepressants, tricyclic Additive anticholinergic side effects Barbiturate anesthetics T Chance of tremor, involuntary muscle activity, and hypotension Barbiturates See Alcohol also, barbiturates may l effect due to T breakdown by liver CNS depressants See Alcohol also, l effect of phenothiazines due to T breakdown by liver Hydantoins T Risk of hydantoin toxicity

Transgenic and knockdown and out mice models of psychiatric disease

The most compelling evidence of a link between genetic variation and the role of the SERT in depression and anxiety led to SERT knockout mice that show increased anxiety-like behaviors, reduced aggression, and exaggerated stress responses. Appropriate functioning of SERT and monoamine oxidase A (MAO-A) during early life appear critical to the normal development of these systems. MAO-A and SERT knockout mice mimic in some respects the consequences of reduced genetic expression in humans. MAO-A knockout mice exhibit high levels of aggression, similar to the elevated impulsive aggression seen in humans lacking this gene. SERT knockout mice may thus represent a more exaggerated version of the reduced SERT expression found in certain subjects, and a partial model of the increased vulnerability to anxiety and affective disorders seen in human subjects with the low expressing allele. Table 5 lists some of the genetically modified mice that have been reported to show depressive or...

Common Features Of Cognitive Vulnerability Models A Framework Encapsulating Relationships

A critical element of many cognitive models is that specific biases of information processing and proximal cognitions are assumed to differ with different disorders (Beck & D. A. Clark, 1997 J. M. G. Williams et al., 1988). For example, the bias in social phobia is for information relevant to the threat of public humiliation, and is accompanied by proximal thoughts like I'll make a fool of myself (see chap. 10, this vol.). The specific bias in panic disorder is for information relevant to unusual bodily sensations that might signal impending heart attacks or other feared calamities, and is accompanied by thoughts such as I'm having a heart attack (see chap. 8, this vol.). Such disorder-specific information-processing biases are presumably instigated when cognitive vulnerabilities (the distal factors) are put into play or engaged that were present long before the symptoms or episode. Hence, the specific vulnerability hypothesis of cognitive models is that the vulnerabilities to...

Common Sound Alike Drug Names

Adriamycin (antineoplastic) albuterol (sympathomimetic) Aldomet (antihypertensive) allopurinol (antigout drug) alprazolam (anti-anxiety agent) Ambien (sedative-hypnotic) amiloride (diuretic) amiodarone (antiarrhythmic) amitriptyline (antidepressant) Apresazide (antihypertensive) Arlidin (peripheral vasodilator) Artane (cholinergic blocking agent) asparaginase (antineoplastic agent) Atarax (antianxiety agent) atenolol (beta-blocker) Atrovent (cholinergic blocking agent) bacitracin (antibacterial) Benylin (expectorant) Brevital (barbiturate) Bumex (diuretic) Cafergot (analgesic) calciferol (Vitamin D) carboplatin (antineoplastic agent) Cardene (calcium channel blocker) Cataflam (NSAID) Catapres (antihypertensive) cefotaxime (cephalosporin) cefuroxime (cephalosporin) chlorpromazine (antipsychotic) chlorpromazine (antipsychotic) chlorpromazine (antipsychotic) Aredia (bone growth regulator) atenolol (beta-blocker) Aldoril (antihypertensive) Apresoline (antihypertensive) lorazepam...

Studies in MS and Other Conditions

Symptoms of MS that have been investigated in some aromatherapy research are anxiety, depression, pain, and insomnia. For anxiety, studies of variable quality indicate that beneficial effects may be obtained with the use of lavender oil, Roman chamomile oil, and neroli (orange) oil. However, no large, well-designed clinical studies have examined this antianxiety effect. Preliminary information suggests that a lower dose of antidepressant medication may be needed by depressed men when the medication is used in combination with aromatherapy using a citrus fragrance. Lavender in bath water does not appear to relieve childbirth-associated pain. Positive and negative results have been obtained in other studies of aromatherapy and pain. Several fragrances, especially lavender, have been evaluated in sleep studies in animals and humans. Some positive results have been reported, but these studies are of variable quality.

Specificity of Cognitive Vulnerability Factors

There is an important distinction for cognitive models between specific and nonspecific causal factors in emotional disorders. Specific causal factors are relatively unique or focal factors in that they influence and predict the development of a particular disorder, but they do not apply equally to all psychopathology in general. For example, some cognitive vulnerability factors may apply to just a single form of anxiety disorder (e.g., just to OCD). In contrast, others may extend to the whole spectrum of anxiety disorders, but not apply to depression or other psychopathology (e.g., chap. 7, this vol. N. L. Williams, Shahar, Riskind, & Joiner, 2004). Alternatively, nonspecific (or common) causal factors potentially cut across a range of different disorders (e.g., depression, anxiety, bipolar disorders, even schizophrenia) and, in this way, have relatively low discriminatory power (Ingram, 1990 see also D. A. Clark, 1997). Two examples appear to include the experience of...

Selective norepinephrine reuptake inhibitors

SNRIs are a class of antidepressants characterized by a mixed action on both major monoamines of depression NE and serotonin. In essence, SNRIs are improved TCAs with less off-target activity, e.g., muscarinic, histaminic and -adrenergic receptors, and MAOI. The combination of inhibition of 5HT and NE uptake confers a profile of effectiveness comparable to TCAs and is reported to be higher than SSRIs, especially in severe depression. SNRIs are purported to be better tolerated than TCAs and more similar to SSRIs without the associated sexual dysfunction seen with the latter. Venlafaxine (38) and milnacipran (4) have been approved so far, and several others are in development. They are active on depressive symptoms, as well as on certain comorbid symptoms (anxiety, sleep disorders) frequently associated with depression. SNRIs appear to have an improved rate of response and a significant rate of remission, decreasing the risk of relapse and recurrence in the medium and long term and...

Overview of Modes of Action A

The pumping capacity of the heart is regulated by sympathetic and parasympathetic nerves (pp. 84, 105). Drugs capable of interfering with autonomic nervous function therefore provide a means of influencing cardiac performance. Thus, anxiolytics of the benzodiazepine type (p. 226), such as diaze-pam, can be employed in myocardial infarction to suppress sympathoactiva-tion due to life-threatening distress. Under the influence of antiadrenergic agents (p. 96), used to lower an elevated blood pressure, cardiac work is decreased. Ganglionic blockers (p. 108) are used in managing hypertensive emergencies. Parasympatholytics (p. 104) and p-blockers (p. 92) prevent the transmission of autonomic nerve impulses to heart muscle cells by blocking the respective receptors.

Obsessivecompulsive Disorder

Obsessive-compulsive disorder, a primary psychiatric disorder, is included here because of its close relation to Tourette's syndrome, where more than half of affected individuals meet criteria for obsessive-compulsive disorder (see Table 59). DSM-IV Diagnostic Criteria for Obsessive-Compulsive Disorder 1. Recurrent and persistent thoughts, impulses, or images that are intrusive and inappropriate and that cause marked anxiety or distress.

Relation Between Cognitive Vulnerability and the Classification of Psychopathology

Emotional disorders can be characterized or classified at different levels of abstraction, and the most appropriate level for focus may depend on the question or circumstances at issue. Consider the case of generalized anxiety disorder and panic disorder. Both are anxiety disorders (at a high level), and for some purposes it may be legitimate to collectively group them as a single disorder. Indeed, this was the case (i.e., in the diagnosis of anxiety neurosis) in classification systems not long ago. The shifts in the diagnostic classification of the two disorders can be interpreted as demonstrating that there are both similarities and differences between these disorders in their underlying causal mechanisms. For example, an underlying core of inappropriate fear would seem a common element of anxiety disorders, yet its manifestations vary in different disorders. For example, the core state of fear is persisting and low grade in generalized anxiety disorder, and its manifestations may...

Special Issues in Assessment of PTSD

High rates of comorbidity are common in PTSD across diverse samples (e.g., males, females, veterans, sexual assault victims, crime victims, the general population), traumatic events (e.g., military, combat, rape, physical assault, childhood sexual abuse, violence), and patient and nonpatient status (help-seeking patients vs. community-based groups Keane & Kaloupek, 1997 Kessler et al., 1994 Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). The most commonly diagnosed comorbid disorders are substance use disorders, mood disorders (e.g., major depressive disorder and dysthymia), and anxiety disorders (e.g., panic and phobias). Unlike other forms of depression seen in the absence of PTSD, when combined with PTSD depression often seems unremitting and in many cases appears as a double depression (i.e., major depressive episodes combined with longstanding dysthymia). In many cases, substance abuse may be secondary to PTSD and represent an effort to self-medicate symptoms. The...

Neuropeptide approaches

SP is an 11 amino acid peptide belonging to the tachykinin family it mediates its biological actions through G tachykinin (NK1) receptors. Evidence to support a major role of the NK1 receptor system in stress-related behaviors has guided the clinical development of several NK1 receptor antagonists, including aprepitant (MK-869 72), lanepitant (73), dapitant (74), vestiptant (75), PD-174424 (76), and NBI 127914 (77). The antidepressant efficacy of the first NK1 receptor antagonist MK-0869 (Aprepitant 72) was demonstrated in patients with major depression and high anxiety, and has recently been replicated with a second compound, L759274. Aprepitant improved depression and anxiety symptoms in a quantitatively similar manner to SSRIs. However, it failed to show efficacy in Phase III clinical trials for depression.11,57 NK2 receptor ligands (e.g., NKP 608 (78), GR159897 (79)) are also under investigation for their potential role in depression and anxiety disorders.

Data Protection Needs to be Matched by Person Protection

Since data protection, in real life, is therefore always limited or compromised, additional measures are needed to protect the individual from disadvantages based on his or her data. Thus, personal protection, in addition to data protection, must be provided. This requires a framework of regulations or laws that govern the use of 'personal medical information' - the latter term is preferred to restricting such protection to DNA-derived data because many 'conventional' medical data carry similar or larger information content, particularly in the area of common complex disease. Such a framework can, in democratically governed systems, only arise as a consensus among all stakeholders involved - among them patients, physicians, insurers, and employers - that represents the optimal compromise which maximizes the benefits for both the individual and society. Such a framework will define which uses of the information are endorsed by society as lawful, and which are shunned as illegal. Given...

Stress Management And Psychiatric Interventions

The modal stress management intervention tested in this regard is a 10-week cognitive behavioral stress management (CBSM) intervention for HIV-positive persons. Throughout previous trials, CBSM was tailored to psychosocial sequelae that may follow critical challenges for HIV-positive persons at various disease stages. In the initial trial, a cohort of 65 MSM awaiting HIV serostatus notification were randomly assigned to a 10-week CBSM intervention, a 10-week group-based aerobic exercise intervention, or a no-treatment control group. After 5 weeks of participating in one of these conditions, blood was drawn for antibody testing and the men received news of their HIV serostatus 72 hours later. Among the approximately one-third of men diagnosed as HIV positive (n 23), those in the control condition reported significant increases in anxiety and depression. In contrast, men in the CBSM and aerobic exercise conditions showed no significant changes in anxiety or depression scores (LaPerriere...

David S Riggs Shawn P Cahill Edna B

Posttraumatic stress disorder (PTSD) is an anxiety disorder that develops in some individuals following exposure to a traumatic event such as combat, sexual or physical assault, a serious accident, or the witnessing of someone being injured or killed (American Psychiatric Association, 1994). The classification of PTSD as an anxiety disorder reflects the longstanding recognition that anxious arousal plays a prominent role in people who experience pathological responses to trauma. However, research and theory into the nature of PTSD have documented that pathological reactions to trauma incorporate many emotions other than anxiety. Accordingly, in addition to reducing trauma-related anxiety and avoidance, treatments for PTSD are expected to modify other negative emotions such as guilt, shame, depression, and general anxiety. Anxiety has played an especially important role in the development of many treatment programs that target PTSD. These programs tend to focus on reducing or managing...

The Theoretical Foundations For Pe

PE is founded on Foa and Kozak's (1986) theory of emotional processing that explains the pathological underpinnings of anxiety disorders and their treatment by exposure therapy. At its core, the emotional processing theory of exposure therapy rests on two basic propositions (1) anxiety disorders reflect the existence of pathological fear structures in memory, which are activated when information represented in the structures is encountered and (2) successful treatment modifies the pathological elements of the fear structure, such that information that used to evoke anxiety symptoms no longer does so. The process of modifying the pathological elements of the fear structure is called emotional processing. Foa and Kozak further proposed that for therapy to successfully modify the fear structure, the fear structure must be activated and corrective information must be incorporated in to it.

Elevated Plus Maze Tmaze

The EPM is a rodent model of anxiety that has been used extensively in the characterization of both established drugs and new chemical entities for anxiolytic activity.37 It is an ethologically based test that uses nonpainful, nonaversive stimuli to induce fear and anxiety thus reducing the possible confounds of motivational and perceptual states. The test is a modification of the Y-maze test that relies on the propensity of a rodent to spend less time in the open areas of the maze than the closed areas. A typical apparatus is the shape of a 'plus' sign and has two elevated arms, one open and one closed. The center of the maze is an open area, and the animal is placed on this center area at the start of the test. Over the course of a 5 min period, the time the animal spends in either the open or closed areas is recorded. Since rodents have an innate fear of height and openness untreated naive animals spend less time on the open versus closed arms, and anxiolytics like diazepam will...

Ontogenic development

By UGT2B7.107 Morphine was found to undergo significant glucuronidation by the fetus liver. In vitro studies in hepatic microsomes obtained from fetuses (15-27 weeks) indicated that the glucuronidation rates were 10-20 of that observed in adult microsomes.108 In addition, the mean rate of morphine glucuronidation in fetal livers obtained after hysterectomy was twofold higher than that obtained from induced abortion livers, suggesting a possible regulatory mechanism for UGTactivity related to the birth process (Table 4).25 The glucuronidation of morphine in vivo has also been demonstrated in premature neonates as young as 24 weeks of gestation. Studies with other substrates which are mainly or partially glucuronidated by UGT2B7, such as naloxone, an opiate agonist, benzodiazepines, and nonsteroidal antiinflammatory drugs are all suggestive of a reduced glucuronidation ability in neonates compared to adults.109

Social Interaction SI Test

The SI test65 was the first ethologically based anxiety model that used natural behavior as a dependent variable. In general, rats are placed together in pairs in a test arena and the time spent interacting with each other (sniffing, grooming, following) is recorded. Environmental manipulations can increase or decrease the amount of time that the rats interact thus allowing for assessment of either anxiolytic (increased interaction) or anxiogenic (decreased interaction) effects of the NCE. The four test conditions are low light, familiar arena (LF lowest level of anxiety) high light, familiar and low light, unfamiliar arena (HU, LU moderate anxiety) and high light, unfamiliar arena (HU highest level of anxiety). To evaluate the anxiolytic effect of compounds, the HU environment is selected while anxiogenic effects can be evaluated using the LF condition. Although this test is relatively easy to set up and run, there are a number of behavioral (single versus grouped housing) and...

Stress Induced Hyperthermia

Stress-induced hyperthermia is an autonomic response that occurs prior to and during stress and or stress-related events.66 The first paradigms used group housed mice and evaluated the change in rectal temperature twice at 10min intervals. The procedure produced reliable elevations in animal core temperatures with anxiolytics reducing the stress-induced hyperthermia response. Later studies showed that similarly robust effects could be produced using singly housed mice, allowing for an average of 10 fewer mice per study. Diazepam and chlordiazepoxide had anxiolytic activity in this model,67 although subunit selective GABAA compounds like Zolpidem exhibited only marginal activity.67 5HT1A receptor agonists (e.g., flesinoxan) have a dose-related inhibition of the hyperthermia response, while partial agonists like buspirone produce a lesser effect.66 In general, antidepressants (e.g., imipramine, chlomipramine, and

Ultrasonic Vocalization USV in Rat Pups

USV is an ethologically relevant anxiety model since it relies on the innate response of rat pups between 9 and 11 days postnatal to emit 35-45 kHz ultrasonic vocalization in response to separation from their mother and littermates.68 Basically, on the day of the study, the pups are separated from their mothers and kept in a warm environment (either home cage or test apparatus) until the NCE is administered. The USV response is assessed via a high-frequency microphone connected to a US signal detection device with data being analyzed to determine the occurrence, frequency, and amplitude of the response.69 Changes in body temperature, motor activity, and respiratory rate can confound USV, so there must be clear evidence that the compound being evaluated does not affect any of these parameters prior to using the USV to evaluate anxiolytic activity.69 BZs (e.g., diazepam), 5HT1A receptor agonists (e.g., flesinoxan, buspirone), and SSRIs (fluvoxamine, chlomipramine) effectively reduce rat...

Rates Of Psychiatric Disorders Among People Living With Hiv Infection

The landmark HIV Cost and Services Utilization Study (HCSUS) found that a large, nationally representative probability sample of adults receiving medical care for HIV in the United States in early 1996 (N 2,864 2,017 men, 847 women) reported major depression (36 ), anxiety disorder (16 ), and drug dependence (12 ) (Bing et al., 2001 Galvan et al., 2002), as well as heavy drinking at a rate (8 ) almost twice that found in the general population and high rates of drug use (50 ). The HCSUS study remains the most comprehensive view we have of the prevalence of psychiatric disorders among people living with HIV AIDS, though the study was not designed as a diagnostic assessment of psychiatric disorders among people with HIV AIDS and so rates of psychosis, bipolar disorder, alcohol abuse or dependence, and substance abuse, among others, were not obtained. Disorders of alcohol and other drug (AOD) abuse are differentiated from dependence in the Diagnostic and Statistical Manual of Mental...

Monoamine Transport Inhibitors

The tricyclic antidepressants (TCAs) were originally designed to improve upon the efficacy and side effect profile of the phenothiazine class of antipsychotics. Their pharmacological spectrum was quite well understood in that these compounds interact with multiple brain neurotransmitter systems. The TCAs inhibit reuptake of monoamine neurotransmitters (dopamine (DA), 5HT, and NE) increasing their levels and function in the brain. TCAs include imipramine, desipramine, nortriptyline, amitriptyline, clomipramine, and doxepin (Figure 5). These compounds also interact with a variety of biological targets like muscarinic receptors, complicating their pharmacology and contributing to side effects such as orthostasis, dry mouth, and constipation. Clomipramine is the most effective TCA for panic disorder, OCD, and SAD87 but more selective reuptake inhibitors have displaced the use of the tricyclics due to their improved side effect profile.

Variations on a Theme Studies of Other Exposure Protocols

Power and colleagues (2002) utilized Marks et al.'s (1998) combined treatment protocol (imaginal and in vivo exposure plus CR), offering patients up to 10 sessions over 10 weeks of exposure therapy or EMDR or wait list. Both active treatments resulted in significant reductions in PTSD severity, anxiety, depression, and functional impairment, and both treatments were superior to the waiting-list condition, which showed very little change. Few differences were observed between the two active treatments, except that EMDR required, on average, fewer sessions (4.2 vs. 6.4) and achieved greater reduction in depression scores. Tarrier et al. (1999) compared an exposure therapy that included only imaginal exposure to CT. Both groups improved significantly from pre- to posttreatment on measures of PTSD, depression, and anxiety, and these improvements persisted through follow-up. There were no differences Bryant, Moulds, Guthrie, Dang, and Nixon (2003a) compared eight sessions of imaginal...

The CRF hypothesis and stress

CRF is synthesized in the hypothalamus and elicits the release of adrenocorticotropic hormone (ACTH) from the pituitary. CRF was isolated from sheep hypothalamus and its structure as a 41-amino-acid peptide determined.96 The hypothalamic paraventricular nucleus (PVN) is the major region in the brain of CRF-containing cell bodies and through axonal projections to the capillaries of the median eminence can secrete CRF directly into the portal system where it acts at the pituitary to regulate ACTH secretion into the circulation. The principal role of ACTH is to stimulate the release of cortisol from the adrenal gland, thus completing the HPA axis, a primary component of the neuroendocrine response to stress. Similarly, projections from the PVN to the lower brainstem and spinal cord have been demonstrated to regulate autonomic function and help to further mediate the behavioral responses to stress. High densities of CRF-containing neurons are localized in particular to prefrontal,...

Subtype Selective GABAa Receptor Modulators

As noted, BZs have been the primary treatment for anxiety for nearly half a century. Despite their proven efficacy and rapid onset of action, their use is limited by side effects, e.g., sedation and amnesia, the development of tolerance, and concerns about dependence and withdrawal.82'102 These side effects are a natural extension of their mechanism of action. Considerable effort has been expended over the past three decades to discover and develop novel, anxioselective BZ ligands that have improved side effect profiles.

Legitimate Pharmaceutical Preparations

1.5.1 benzodiazepines The benzodiazepines form one of the largest classes of abused pharmaceuticals. These products are sedative hypnotics, tranquilizers, and anti-anxiety drugs and they produce a calming effect and are often prescribed as tranquilizers. The drugs in this class are numerous and are included under Schedule IV control because while they do have a potential for abuse, there are recognized medical benefits that are both physiological and psychological. The most frequently diverted and abused benzodiazepines are alprazolam (Xanax ) and diazepam (Valium ). Other frequently abused benzodiazepines are lorazepam (Activan ), triazolam (Halcion ), chlordiaz-epoxide (Librium ), flurazepam (Dalmane ), and temazepam (Restoril ). Another phenomenon that has been noted for several years is the abuse of legitimate pharmaceuticals in conjunction with illicit controlled substances. Clonazepam (Klonipin ) is just such a product. It is an anxiety reducer that is used in combination with...

Metabotropic Glutamate Receptors

G protein-coupled receptors for glutamate, metabotropic glutamate receptors (mGlu), play a diverse modulatory role in neurotransmission and are potential targets for novel anxiolytic drugs.124 The eight known mGlu receptors are divided into three families, group I (mGlu15), group II (mGlu23) and group III (mGlu ), based on structure, pharmacology, and signal transduction. The focus for anxiolytics has been on group I and II mGlus, although data from mGlu7 and mGlu8 knockout mice suggest that group III receptors may also be relevant for altered anxiety and stress responses.

Group II mGlu agonists

MGlu2 and mGlu3 are expressed in brain areas important for anxiety disorders, e.g., amygdala, hippocampus, and prefrontal cortex. mGlu2 receptors are located on glutamate-releasing nerve terminals where they suppress glutamate release, whereas mGlu3 is found both pre- and postsynaptically, and on glia. Activation of group II mGlus also suppresses the release of GABA, monoamines, and neuropeptides.125 The constrained glutamate analogs LY354740 and MGS 0028 (Figure 11a) are potent, selective agonists of mGlu2 and mGlu3 receptors.124'126 Systemic administration of LY354740 produces anxiolytic effects in a range of animal models, including fear potentiated startle, EPM, and conflict tests. Where compared, the anxiolytic effects of these compounds are similar to those for standard BZs, but occur in the absence of sedation or ataxia. LY354740 may, however, disrupt memory processes in animals,127 although the compound reduced ketamine-induced deficits in working memory in humans.128 LY354740...

Group I mGlu antagonists

MGlu1 and mGlu5 have reciprocal distributions in the brain and are located predominantly postsynaptically where they are thought to augment neurotransmission. Antagonists of both mGlu1 and mGlu5 have shown anxiolytic activity in animal models.124 For mGlu1 antagonists, the glutamate analog AIDA (Figure 11c) and the allosteric antagonist JNJ16259685 are both effective after systemic administration in the Vogel test, and positive results were also reported for AIDA in the EPM and open field, but not the four-plate test.131,132 The mGlu5 allosteric antagonist MPEP was efficacious in fear-potentiated startle, EPM, conflict tests, and stress-induced hypothermia with systemic administration,124,133 as was the analog MTEP (Figure 11c).134 In general, anxiolytic effects were observed without sedation however, group I mGlu receptors are involved in learning and memory processes, consequently blockade of mGlu1 and mGlu5 may be problematic in this respect. Fenobam (Figure 11c), a drug...

Dissemination Of Pe For Ptsd

Over the last several years we have trained many professionals from various disciplines in workshops lasting from 2 hours to 5 days. Clinicians commonly report that they are attracted by the efficacy and efficiency of exposure therapy and are interested in using it with patients who have PTSD. However, they are also worried about being able to properly implement it without further assistance, and we strongly believe that few of these clinicians actually end up using PE in their practices. Although an extended workshop (e.g., 3-5 days) may be adequate for training clinicians who have a background in CBT and experience in utilizing exposure therapy with other disorders (e.g., phobias, panic disorder, obsessive-compulsive disorder), therapists trained in other models of psychotherapy (e.g., psychodynamic,

Current Classification Systems

Inappropriate Stimulus Control of Behavior. Maladaptive responses may arise from formerly innocuous and inappropriate stimuli that have acquired the capacity to elicit highly intense emotional reactions. This category involves autonomic reactivity and the physiological response. Disorders are reflected in a wide variety of somatic complaints, including muscular tension, anxiety, phobia, insomnia, fatigue, gastrointestinal disorders, and cardiovascular disturbances. Control of the previously innocuous stimuli is brought about through aversive and vicarious classical conditioning.

Model I Intensive Initial Training of Therapists Plus Ongoing Expert Supervision

In the first step of dissemination, Center for the Treatment and Study of Anxiety (CTSA) experts provided the community therapists with a 5-day intensive workshop that included an introduction to the theory and efficacy data supporting the use of PE in the treatment of PTSD as well as instruction Participants were recruited through the CTSA and the community agency and were randomly assigned to PE, PE CR, or waiting-list (WL) conditions at each location. Like the community therapists, CTSA therapists participated in weekly supervision meetings that included discussion about ongoing cases and the viewing of videotapes of therapy sessions. Indeed, the supervision established at the community agency was modeled after our standard supervision practices at the CTSA. As noted in the section on the efficacy of PE, the results from this study revealed that both treatments resulted in greater reductions in symptoms of PTSD, anxiety, and depression than the WL condition and that both treatments...

NOC Respiratory Status Gas Exchange

Observe for early stages of hypoxemia and effects on nervous system (mood changes, anxiety, confusion), circulatory system (tachycardia, hypertension), respiratory system (altered depth and pattern, dyspnea, retractions, grunting, prolonged expiration), gastrointestinal system (anorexia). Promotes rest and ease of respiratory effort to support ventilation, especially if anxiety present (action of drug). Reduces anxiety, which reduces oxygen requirements in the child.

What Kind Of Responses To Trauma Should Mental Health Practitioners Be Concerned About

In most discussions of long-term pathologic responses following a traumatic event, there is an implicit assumption that the critical outcome being referred to is PTSD. Yet, PTSD is but one among several possible outcomes following trauma exposure. Trauma survivors, compared to persons who have not experienced trauma, are at increased risk for the development of other mental disorders, such as major depression, panic disorder, generalized anxiety disorder, and substance abuse, as well as persistent anxiety symptoms and distress that do not meet criteria for a specific psychological disorder 3 . Furthermore, they are at risk for developing somatic symptoms and physical illnesses, particularly hypertension, asthma, chronic pain syndromes and other psychosomatic illnesses. Interestingly, the focus of most investigations in the wake of disasters that affect large numbers of persons, whether they be natural or man-made events, has been related to PTSD, even though this disorder is neither...

Communication Guidelines

Various guidelines for risk counselling are now available (Richards et al. 1995 Eisinger et al. 2004). A multistep process has been proposed (Julian-Reynier et al. 2003), starting with assessment of the counselee's preconceptions, knowledge, preferences, expectations, anxiety and coping style in order to tailor the risk communication process. The information to be given to the counselee (risk, magnitude, uncertainty, for

Core Predictors Of Chronic Dysfunction In The Acute Phase

Closely related to dissociation is the potentially important role of panic during and after trauma exposure. There is evidence that panic attacks occur in 53-90 of trauma survivors during the traumatic experience 20 . Further, the majority of people with ASD report peri-traumatic and posttraumatic panic attacks 21 . Galea et al. 1 found peri-traumatic panic to be the best predictor of PTSD in the post September 11 survey of 1,008 residents living south of 110th Street in Manhattan. This observation is consistent with the results of a study of 747 police officers in which panic reactions during exposure were highly predictive of post-September 11 symptom development 22 .

How to Work with Your Doctor

When I was growing up, doctors behaved very differently from the way they do today. For one thing, they went out of their way to suppress information about alternative diagnoses, risks of treatment, and prognoses. They did this because they felt that part of their job was to shoulder the anxiety related to these sometimes horrible possibilities and conceal them from the patient and patient's family. When a fatal outcome was likely, telling the patient was taboo. Some physicians are still made uneasy by patients who read up on their disease and or proposed treatments and come to the office with a lot of difficult questions, or worse yet, with specific demands, for example, for specific drugs they have seen advertised. Patients want to trust their doctors, and to leave the anxiety to the doctor. But patients need to know that all of the possibilities have been taken into consideration, that their doctor is completely informed, and most of all, that he or she is really concerned about...

Models of behavioral determinants

Social psychologists and health education researchers have developed models for explaining individual behavior in general, i.e., health behavior, environmental (hygiene) behavior, political choices, etc. Extreme anxiety behavior or addictive behavior, however, can not be explained with these models. The majority of dietary behaviors, which are important from a health point of view, can be explained. A prerequisite for using the models is that the behavior that has to be explained is under a person's control and that the person is aware of the options. This does not mean though that people always have to be completely conscious of these behavioral choices. Many of them are made implicitly, especially those which have become habits.

The Role Of Biological Studies In Helping To Identify Pathological Responses

Biological findings in PTSD have become increasingly relevant to the issue of the identification of psychopathology. Initially, the biology of stress and the stress response was adopted as a relevant model for the study of PTSD. This assumption provided the intellectual justification for interpreting PTSD as one manifestation along a continuum of ''normal'' responses to adversity. Although a comprehensive review of the neurobiology of PTSD is beyond the scope of this chapter, the results of neurobiological studies of PTSD pertain directly to the issue of the identification of PTSD as a pathological or non-normative response to trauma. Most relevant to this discussion are the repeated observations and nature of a distinct set of biological alterations associated with PTSD symptoms (see 36). At least some of the biological alterations that have been observed reflect changes in stress-responsive systems (e.g., the hypothalamic-pituitary-adrenal axis) that are quite different from what...

Primary Sleep Disorders Dyssomnias

Psychogenic insomnia is characterized by increased mental tension (inability to relax, anxiety, brooding) and excessive 1 1 concern about sleep itself (constant complaining about an inability to fall asleep or stay asleep, or about waking up too early). Sleep often improves in a new environment (e. g., on vacation).

Pharmacologic Highlights

During episodes of chest pain, encourage complete rest and allay the patient's anxiety by remaining close at hand. Monitor the blood pressure and heart rate, and initiate collaborative interventions such as administering nitroglycerin and oxygen. If the pain does not subside, notify the physician. When the episode is over, ask the patient to grade the severity of the pain (1 is low pain and 10 is severe pain), and document it in detail.

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