Update on anxiety disorders

Article Abstract:

This editorial briefly reviews anxiety disorders, a psychiatric diagnostic category that includes a broad range of conditions such as simple phobias, obsessive compulsive disorder (OCD), panic disorder, and agoraphobia (fear of public places or specific situations). Currently considered the most common psychiatric illnesses, anxiety disorders affect slightly more than 14.6 percent of all Americans at some point in their lifetimes. A review of recent progress in treating these conditions appears in the May 1991 issue of the Archives of Internal Medicine. Panic disorder, characterized by panic attacks in which the patient experiences acute, intense anxiety, is a severe illness; as many as 20 percent of those who suffer from it attempt suicide. Awareness of these conditions should extend into other areas of medicine because afflicted patients often seek medical care outside psychiatry. They may visit cardiologists because of irregular or rapid heartbeat, or gastrointestinal or respiratory specialists. Even in psychiatric settings, patients with panic disorder can be incorrectly diagnosed, since many are also depressed and some are alcoholic. Modern classification systems for the anxiety disorders first appeared in the 1981 revision of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, third edition. OCD is more common than is usually thought, affecting 2.5 percent of Americans. Many OCD patients can be successfully treated with clomipramine hydrochloride (Anafranil). Other anxiety disorders are discussed. A brief review is presented of models that have been formulated to explain certain kinds of panic attacks and OCD. An important treatment issue is the use of benzodiazepines, drugs that are effective for treating anxiety disorders but that are often withheld from patients out of concern that they may be abused. Patients without histories of substance abuse do not usually misuse benzodiazepines, however. Patients suffering from anxiety often have disorders that are chronic and severe, but that are increasingly treatable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Affective disorders, Mood disorders, Panic disorders, Panic disorder, Obsessive-compulsive disorder, Obsessive compulsive disorder, editorial, Clomipramine

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Metoclopramide-induced movement disorders

Article Abstract:

Metoclopramide is commonly used to treat vomiting. It has lately been used to treat urinary bladder problems, hypertension or elevated blood pressure, and amenorrhea, the absence of menstruation. The drug acts to block cellular receptors to dopamine, a substance occurring throughout the body that acts as a chemical mediating substance, especially in the brain to facilitate communication among brain cells. Metoclopramide has also been used recently to prevent the nausea and vomiting that can accompany chemotherapeutic treatment of cancer and AIDS, acquired immunodeficiency syndrome. The drug itself, however, has side effects that result from its action at blocking receptor sites in the brain for appropriate neurotransmitters, dopamine receptors. Movement disorders that appear similar in nature to Parkinsonism, so-called extrapyramidal reactions, have been reported. The manufacturer, A.H. Robins, reported that such reactions only occurred in one of 50 patients treated with the drug. This retrospective study reviewed the medical history of 131 patients with drug-induced movement disorders. Of this population 16 patients or 12.2 percent of patients with drug-induced movement disorders were found to have been treated with metoclopramide. The statistically average patient in this group was 63 years old, three times more likely to be female, had an average exposure to the drug of one year before onset of symptoms, and had continued therapy for an average of six months after the development of a movement disorder. Physicians should be aware of the possibility of troubling movement disorders resulting from long-term therapy with metoclopramide.

Causes of, Complications and side effects, Metoclopramide, Hormone antagonists, Movement disorders

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A practical update on anxiety disorders and their pharmacologic treatment

Article Abstract:

A review is presented of the symptoms and treatment of anxiety disorders, common psychiatric conditions that affect many people and often begin early in life. Anxiety can be present as a primary disorder, in association with other psychiatric conditions, or in association with medical conditions. Primary anxiety disorders include: panic disorder (PD, characterized by extremely intense anxiety which can lead patients to be afraid that they are dying); agoraphobia (fear of being in public places or situations from which escape is difficult in case of a panic attack); social phobia (avoidance of situations where one is under scrutiny, such as in public bathrooms); simple phobias (such as fears of animals or of seeing blood); generalized anxiety disorder (GAD, fluctuating anxiety not associated with discrete panic attacks or phobias); obsessive-compulsive disorder (OCD, recurrent, obsessive thoughts or behaviors); and posttraumatic stress disorder (PTSD, a response to overwhelming trauma). Anxiety disorders are treated with behavioral or cognitive therapy and drugs; however, accurate diagnosis is the first step in selecting the appropriate treatment. The drugs used to treat anxiety disorders are reviewed: they include benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors, and other agents. Administration of more than one drug may be effective for some patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Anxiety, Psychopharmacology

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