¶ … Anxiety Disorders Diagnosis of anxiety disorders

Diagnosis

Differential diagnosis

Generalized anxiety disorder (GAD)

Ethical issues in Psychopharamacology

In this paper, we present an elaborate analysis of anxiety disorders involving symptoms, diagnosis as well as the differential diagnosis. The aim of this paper is however to discuss the Psychopharamacological of anxiety disorder with specific discussion of the medication for every case. The ethical considerations on Psychopharamacological are also presented.

Anxiety disorders are noted by Oakley-Browne (1991) as some of the most common as well as disabling disorders which affects both adult and adolescents alike. An Epidemiological Catchment Area (RCA) study indicated that about a quarter of individuals will experience disability severe symptoms as well as handicap as a result of anxiety disorders at a certain instance of their lives. The anxiety disorders are generally associated with a significant level of morbidity (Markowitz et al., 1989) as well as an increase level of mortality. This is due to the high rate of suicide cases among the sufferers. Cassano, Rossi and Pini (2002) noted that the direct as well as indirect costs of anxiety disorder to the economy and health services are considerable. Even though a large number of suffers are consumers of the general types and forms of health services, a limited number resort to seeking specific and specialized help.

Types of anxiety disorders

Cassano, Rossi and Pini (2002) indicated that a wide spectrum of disorders (anxiety disorders) exists and they include generalized anxiety disorder (GAD), agoraphobia and panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD) and phobic disorder.

Diagnosis of anxiety disorders

The discovery of new and latest types of psychotropic medications means that the specific diagnosis of anxiety disorders within the available spectrum is paramount due to the fact that each of the types of anxiety disorders are responsive to specific forms of pharmacotherapy. While performing the diagnosis, it is essential to note that depression and anxiety are usually comorbid conditions.

The cause of anxiety disorder is still unknown. They are not a consequence of a weak personality, character flaw or any form of poor upbringing.

Diagnosis

Should anxiety disorder be suspected, the doctor would usually begin with a rigorous evaluation by asking the patient about their medical history as then conducting a physical examination. There are no special laboratory tests for diagnosing anxiety disorders. Doctors may however employ tests aimed at detecting any form of physical illness that may be the cause of the observed and reported symptoms. An absence of any form of physical illness may invoke a referral to a psychologist or a psychiatrist who is trained in the diagnosis and treatment of mental illnesses. The psychologist or psychiatrist would then employ a special interview as well as an assessment tool to be used for the evaluation of the patient for anxiety disorder.

Differential diagnosis

If manifestations of anxiety are reported without any obvious triggers or when they are out of proportion in relation to a specific situation, they can effectively be considered to be anxiety symptoms. Should the symptoms persist and be maladaptive as well as meet the set diagnostic criteria, then they can be regarded as a syndrome. If specific diagnostic criteria are met in regard to the consistency, duration as well as repetitiveness, then the symptoms can be described as an anxiety disorder.

Symptoms of anxiety are the most common psychiatric symptoms that are reported in AOD abusers. The anxiety symptoms that are induced by AOD or withdrawal from AOD are noted to resolve normally, within a couple of days or even weeks (SAMHSA,1993).

Certain medications have been noted to cause anxiety and they include cold medicines, antispasmodics, digitalis, thyroid supplements as well as other over the counter diet medications. Narcoleptic drugs and Methylphenidate (Ritalin) are indicated by SAMHSA (1993) to cause anxiety. Steroids are also noted to cause hyperactive as well as other forms of idiosyncratic reactions. Similar panic can also be caused by nicotine and caffeine.

The differential diagnosis for social phobia and agoraphobia include various forms of avoidance behaviors that are manifested as part of depression, paranoia and schizophrenia.

Generalized anxiety disorder (GAD)

The differential criteria for generalized anxiety disorder (GAD) are major depression, dysthymic disorders, adjustment disorders with anxious mood, dementia, organic factors as well as adverse effects of other types of drugs (NPS,2009).

Acute stress disorder

The differential criteria for acute stress disorder is Post-traumatic stress disorder

Adjustment disorder with anxious mood

The differential criteria for Adjustment disorder with anxious mood is Generalized anxiety disorder

Panic attack

The differential criteria for panic attack are acute physical illness such as heart attack, asthma and stroke.

Post-traumatic stress disorder

The exact method of treatment is however dependent on the specific type of disorder. However, one or a combination of the following approaches can be employed in the treatment of anxiety disorder'
Medication, psychotherapy, cognitive-behavioral therapy (CBT), dietary as well as lifestyle changes as well as relaxation therapy. In this paper we concentrate on medication / Psychopharamacological interventions

Initially, selective serotonin reuptake inhibitors (SSRIs) that are designed to help in the treatment of depression are noted to be effective in the treatment of anxiety disorders.Thes einhibitors are noted to have revolutionized anxiety treatment and have replaced the chronic application of benzodiazepines. selective serotonin reuptake inhibitors (SSRIs) are noted by Cassano, Rossi and Pini (2002) to be effective interventions against OCD, PSTD, PDs as well as GAD. The other antidepressants that includes tianeptine are noted by Cassano, Rossi and Pini (2002) to be effective in the treatment of adjustment disorders in the cases of anxiety as well as depression disorders. The SSRIS' dose for the anxiety disorder are noted to be generally higher than for depression. Tricyclic antidepressants (TCAs) are also effective against anxiety disorders but other side effects such as drowsiness, toxicity as well as anticholinergic side effects have made them less popular. Monoamine oxidase inhibitors (MAO Is) are also noted to be effective against anxiety but their side effects and dietary restricts make their application to become limited. In the next section we describe the exact the various drugs that can be used in the treatment of specific anxiety disorders.

Generalized anxiety disorders (GAD)

Benzodiazepines

Extant literature has indicated that Benzodiazepines are more effective in the treatment of GAD when compared to placebo (Greenblatt,1974; Greenblatt, Shader and Abernethy.1983; Rickels et al.,1983 ).There is sufficient evidence that Benzodiazepines are more effective in the suppression of specific symptoms of GAD and especially the somatic as well as autonomic symptoms in comparison to the psychic symptom cluster that includes irritability and worry (Rickels et al.,1982).Irritability has been indicated to worsen in cases of high potency Benzodiazepines (Rosenbaum et al.,1984).Information gathered from 6-8 months of maintenance therapy have generally revealed continued efficacy over a period of time (Rickels et al.,1983). It is worth noting that since Generalized anxiety disorders (GAD is a long-term as well as unremitting disorder (Blazer et al.,1991), pharmacotherapy must be continued (whether Benzodiazepines or not ) for several years in most patients.

The outcome of several studies indicates that seventy percent of patients will positively respond to adequate treatment with Benzodiazepines (up to about 40mg per day of the medication diazepam p or a 3-week equivalent).However, close to two thirds of the patients will achieve a degree of remission of the symptoms. Long-term usage does not produce tolerance to the side effects. In regard to tolerance as the withdrawal symptoms, compounds such as oxazepam will exhibit little amount of reinforcing potential in comparison with the long half-life one like diazepam as well as chlordiazepoxide, which have a lower propensity to elicit withdrawal symptoms.The discontinuation of theproces sof acute treatment should be carried out in slow manner in order to slow down the potential for a relapse.

Azapirones

Azapirones

Azapirones are another pharmacological treatment used for the treatment of GAD. Buspirone is also administered to patients in doses of 3-4 doses of up to 60 mg per day.

Antidepressants

Antidepressants are noted to be the well established treatment option for the various types of anxiety disorders (OCD.PD, PTSD and social phobia). The role of antidepressants is to treatment of GAD remains largely unknown. The benefits of Kahn et al., (1986) and Hoehn-Saric et al.,

Panic disorder

Panic disorder is also treated with Benzodiazepines. In studies regarding the efficacy of BZ on the treatment of panic disorder indicated that there was a lot of improvement in all the major symptoms such as the number of panic attacks, residual anxiety between the attacks as well as avoidance behavior (Ballenger ate al,1988).Similar efficacy was shown by other high potency Benzodiazepines such as lorazepam (Rickels et al.,1986) and clonazepam (Chouinard, Labonte, Fontaine,1983).

Antidepressants

Antidepressants have also been noted to help in the treatment of panic disorder.

Social anxiety disorder

Benzodiazepines such as Clonazepam have been indicated to effectively treat Social anxiety disorders. Gelernter et al. (1991) compared the use of alprazolam in the treatment of social anxiety disorders and reported a positive outcome.

Antidepressants

Just anecdotal evidence is in support of the efficacy of TCAs in the treatment of the social anxiety disorder (Van Vliet, Den Boer and…