Anxiety Disorders (eBook)

Series Editor’s Introduction 6
Foreword 8
Preface 10
Acknowledgments 14
Table of Contents 16
Contributors 18
Overview of Anxiety and the Anxiety Disorders 19
Anxiety Disorders 21
Biopsychosocial Factors 24
Understanding Fear And Anxiety 25
Anxiety: Neurons And Neurochemistry 27
How A Neuron Works 28
Serotonin System 28
Norepinephrine (Noradrenergic) System 28
gama-Aminobutyric Acid 29
Treatment Of Anxiety Disorders 29
History of Treatment 29
Primary Care Assessment 29
Treatment Modalities 30
Psychotherapy 31
Pharmacotherapy 31
Education 32
Principles of Psychopharmacotherapy 32
When to Seek Assistance from a Mental Health Professional 33
References 35
Brief Psychiatric History and Mental Status Examination 37
Evaluating Anxiety Disorders 37
Diagnosis of Anxiety Disorders 38
Screening for Anxiety Disorders 41
Anxiety Disorders and General Medical Disorders 44
Brief Psychiatric Evaluation 45
Psychiatric History 47
Anxiety Disorder Screening Instruments 48
Primary Care Psychiatric Evaluation Guideline (PCPEG) 51
Chief Complaint/Reason for Evaluation 51
History of Present Illness 51
Past History 51
Current Medications 52
Allergies 52
Substance Use 52
Personal/Social History 52
Family History 52
Review of Systems 52
Physical Examination 52
Mental Status Examination 53
Functional Assessment/Differential Diagnosis 53
Treatment Plan 53
References 54
Psychopharmacology 57
Neurotransmitters 58
Receptors 59
Serotonergic System 59
Serotonin Receptors 60
Noradrenergic System 61
Dopaminergic System 61
Cholinergic System 62
Gabaergic System 63
Glutamatergic System 63
Neuropeptides 64
Pharmacokinetics and Pharmacodynamics 65
Pharmacokinetics 66
Absorption 67
Distribution 73
Metabolism 74
Elimination 74
Multiple Dosing and Steady State 75
Pharmacodynamics 76
Tolerance 77
Dose-Effect Relationship Variability 77
Summary 79
References 79
Psychopharmacotherapy 81
History of Anxiolytics 81
Treatment 83
Pharmacotherapy 84
Antidepressants 84
Selective Serotonin Reuptake Inhibitors 84
Pregnancy and Lactation 96
Serotonin-Norepinephrine Reuptake Inhibitors 99
Benzodiazepines 102
Clinical Characteristics 104
Mechanism of Action 105
Pharmacokinetics 106
Adverse Effects 107
Drug Interactions 107
Tolerance 108
Physical Dependence, Discontinuation, and Abuse 108
Pregnancy 110
Azapirones: Buspirone 113
Action 114
Pharmacokinetics 114
Clinical Use 115
Adverse Effects 115
Tricyclic Antidepressants 116
Pharmacokinetics 117
Clinical Use 118
Adverse Effects and Risks 118
Metabolism and Drug Interactions 120
Pregnancy and Lactation 121
Monoamine Oxidase Inhibitors 121
Use in Anxiety Disorders 122
Side Effects and Interactions 122
Hydroxyzine 123
Adverse Effects 124
Other Medications for Common Anxiety Disorders 124
Generalized Anxiety Disorder 124
Social Anxiety Disorder 125
Panic Disorder 125
Obsessive-Compulsive Disorder 125
Posttraumatic Stress Disorder 125
Summary 126
References 126
Psychotherapy 131
Psychotherapeutic Approaches 132
Insight-Oriented Psychotherapy 132
Person-Centered Psychotherapy 132
Behavior Therapy 133
Cognitive Therapy 133
Efficacy and Effectiveness of Psychotherapy in Treating Anxiety Disorders 133
Cognitive Behavior Therapy Approach for Treating Anxiety Disorders 138
Evaluation and Education 138
Skills Acquisition 139
Exposure Therapy 140
Collaboration Between Primary Care practitioners And Psychotherapists 141
Making the Referral 142
Medication Management 142
Monitoring Progress in Psychotherapy 143
Summary 145
References 146
Adjustment Disorder with Anxiety 147
Associated Features 148
Epidemiology 149
Course and Prognosis 149
Etiology 149
Differential Diagnosis 150
Treatment 150
Summary 152
References 152
Panic Disorder 153
Definition 153
Incidence and Prevalence 153
Further History: Important Areas to Consider During the Workup 155
Diagnosis 155
Agoraphobia 156
Etiology Theories 156
Neurobiology 157
Treatment 157
Medication 158
Benzodiazepines 158
Selective Serotonin Reuptake Inhibitors 158
Other Medication Treatments 159
Further Drug Considerations 159
General Considerations of Treatment 161
Benzodiazepine Abuse Potential 161
Comorbidity 161
Treatment Compliance 162
Cognitive Behavior Therapy 162
Summary 164
References 164
Specific Phobia 167
Associated Features 169
Epidemiology 169
Onset 169
Etiology 170
Treatment 172
Therapy 172
Pharmacotherapy 173
Summary 174
References 174
Social Phobia (Social Anxiety Disorder) 177
Definition 177
Diagnosis 177
Avoidant Personality Disorder 179
Treatment 179
Psychotherapy 179
Pharmacological Treatment 179
SSRIs/SNRIs 179
Benzodiazepines 180
Other Pharmacological Therapy 181
Beta-Blockers 181
Buspirone 181
Atypical Antipsychotics 182
Tricyclic Antidepressants 182
Monoamine Oxidase Inhibitors 182
References 184
Obsessive-Compulsive Disorder 185
Definition 185
Diagnosis 186
Obsessive-Compulsive Personality Disorder 187
Treatment 188
Cognitive Behavior Therapy 188
Medical Therapy 188
Benzodiazepines 188
Newer Therapeutic Approaches 189
References 191
Posttraumatic Stress Disorder 193
Definition 193
Comorbidity 193
Neurobiology 195
Acute Stress Disorder 195
Treatment 196
Psychopharmacology 196
Psychotherapeutic Interventions 197
Psychoeducation and Support 197
References 198
Generalized Anxiety Disorder 201
Definition 201
Etiology 202
Evaluation 203
Rating Scales 203
Medical Disorders 203
Substance Abuse 204
Comorbidity 204
Treatment 204
Cognitive Behavior Therapy 204
Pharmacotherapy 205
Benzodiazepines 205
Selective Serotonin Reuptake Inhibitors 205
Buspirone 207
Serotonin-Norepinephrine Reuptake Inhibitors 207
Tricyclic Antidepressants 207
Monoamine Oxidase Inhibitors 208
Other Treatments 208
References 210
Anxiety Disorder Due to a General Medical Condition 213
Definition 214
Common Medical Conditions Associated With Anxiety 214
Chronic Obstructive Pulmonary Disease 214
Asthma 215
Medication-Related Anxiety in Chronic Obstructive Pulmonary Disease/Asthma 216
Heart Disease 216
Hyperthyroidism 219
Dietary Intake 219
Cancer 220
Irritable Bowel Syndrome 221
References 224
Anxiety Disorders and Comorbidities 227
History 227
Anxiety Disorders With Comorbid Depression 228
Risk Factors For Anxiety Disorders and Depression 229
Treatment of Anxiety Disorders and Depression 230
Treatment of Anxiety Disorders with Comorbid Depression 231
Anxiety Disorders and Comorbid Bipolar Disorder 232
Mood Stabilization 233
Anxiety Disorders and Comorbid Adult Attention-Deficit Hyperactivity Disorder 233
Anxiety Disorders and Comorbid Personality Disorders 234
Definitions of Each Personality Disorder as Listed In The DSM-IV-TR 235
Anxiety Disorders and Comorbid substance Abuse 236
References 237
Geriatric Anxiety and Anxiety Disorders 239
Pharmacokinetics and Aging 240
Differential Diagnoses in Geriatric Anxiety 243
Depression in the Elderly 243
Dementia 244
Delirium 246
Treatment 247
Medication Compliance 247
Medical Therapy 248
Benzodiazepines 248
Selective Serotonin Reuptake Inhibitors 248
Tricyclic Antidepressants 252
Other Medication Treatment Options 252
Cognitive Behavior Therapy 254
References 259
Anxiety Disorders Resources 261
Glossary 265
Index 277