Overview
Anxiety - Classification, Causes
Anxiolytics - Types, Mechanism of Actions
Benzodiazepines - Therapeutic use,
Pharmacokinetics, Side effects, Overdose/withdrawal, Drug-drug interactions,
Receptor activity
Barbiturates - Adverse effects
Others - Carbamates, Buspirone
Anxiety
Anxiety
is a vague feelings of apprehension or fear when natural human experience to
stress. Everyone experiences it in their life and it becomes a problem when it
is in excess, irrational, uncontrollable, and disruptive.
Anxiety
disorders are a group of psychiatric conditions that involve excessive anxiety.
Manifestations
of Anxiety
Verbal
complaints - The patients say he/she is anxious, nervous
Somatic
and autonomic symptoms - The patient is restless and agitated, has tachycardia,
increased sweating, disturbed sleep (insomnia), weeping and often
gastrointestinal disorders
Social
effects - Inteference with normal productive activities
Anxiety
may be a single episode or chronic disorder
Classification
of Anxiety
·
Types
of Anxiety Disorders
·
Obsessive-Compulsive
Disorder
·
Post-Traumatic
Stress Disorderr
·
Generalized
Anxiety Disorder
·
Panic
Disorder
·
Phobias
Obsessive-Compulsive
Disorder
Obsessions
- irrational, disturbing thoughts that intrude into consciousness
Compulsions
- repetitive behaviour or rituals performed to alleviate obsessions
Performance
of these rituals neutralize the anxiety, however relief is only temporary
- Cleaning: repeatedly washing hands or
cleaning home
- Checking: check several or even hundreds of
times to make sure that stoves are turned off or doors are locked
- Repeating: some repeat a name, phrase or
action over and over
Post-Traumatic
Stress Disorder (PTSD)
PTSD
is an anxiety triggered by recall of past stressful experiences or traumatic
event such as war, natural disaster, serious accident, rape or assault
Symptoms
may include:
-nightmares
-sense
of event recurring or flashbacks
-avoidance
behaviour in terms of activities, situations, people
-hypersensitivity:
sleeplessness, anxious feeling, irritability, outbursts of anger
Generalized
Anxiety Disorder
GAD
is an ongoing state of excessive anxiety lacking any clear reason
It
is a continual apprehension and anxiety about future events and the worry seriously
interferes with functioning and daily routines
Physical
symptoms may include headaches, stomachaches, muscle tension and irritability
Panic
Disorder
Panic
disorder is a sudden attacks of overwhelming fear occur in association with
marked somatic symptoms
Symptoms may include:
-sweating
-palpitations
-chest
pains
-breathlessness
-dizziness
or lightheadness
-chills
or hot flushes
Phobias
Phobias
is a strong irrational fear of specific objects or situations. It is considered
phobic if these fears interfere with normal behavior
Specific
phobias
- fear of specific object
-animals
(eg. snakes)
-substances
(eg. blood)
-situations
(eg. height)
-it
occurs more often in females than males
Social
phobias
- fear of failing or being judged in public
-public
speaking (stage fright)
-fear
of crowds, strangers
-meeting
new people
-eating
in public
-equally
often in males and females
In
extreme casesthis intense uneasiness can progress into a full blown panic
attack
Pathophysiology
Pathophysiology
of anxiety is unclear and may result from imbalances in neurotransmitters. It
may be due to excess of norepinephrine or deficiency of inhibitory subtances
such as gamma aminobutyric acid (GABA).
Serotonin
also plays a role in anxiety but the mechanism is unclear.
Causes of
Anxiety
Medical
- respiratory, endocrine, cardiovascular, metabolic, neurologic
Drug-induced
- Stimulants (amphetamines, cocaine,
caffeine)
- Sympathomimetics
(ephedrine, epinephrine, pseudoephedrine)
- ANticholinergics /
Antihistaminergics (trihexyphenidyl, benztropine, diphenhydramine)
- Dopaminergics
(bromocriptine, L-Dopa)
Drugs
Withdrawal - Benzodiazepines, narcotics, barbiturates, other sedatives, alcohol
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