This document discusses anxiety disorders and related conditions. It covers the epidemiology, diagnostic criteria, neurobiology, and treatment of disorders like generalized anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and phobias. Key points include that anxiety disorders often begin in adolescence or early adulthood, are more common in females, and can cause significant impairment. Treatment involves psychotherapy such as cognitive behavioral therapy as well as medication, with SSRIs being a first-line pharmacological option.
It is an emotional state, unpleasant in nature, associated with uneasiness, discomfort and concern or fear about some defined or undefined future threat. Some degree of anxiety is a part of normal life. Treatment is needed when it is disproportionate to the situation and excessive.
What is Generalized Anxiety Disorder (GAD)?Raj Mane
Generalized anxiety disorder (GAD) is a mental health condition that causes dread, worry, and overwhelm. Excessive, persistent, and unreasonable concern over everyday events characterizes it.
https://bit.ly/3Jmoj5R
It is an emotional state, unpleasant in nature, associated with uneasiness, discomfort and concern or fear about some defined or undefined future threat. Some degree of anxiety is a part of normal life. Treatment is needed when it is disproportionate to the situation and excessive.
What is Generalized Anxiety Disorder (GAD)?Raj Mane
Generalized anxiety disorder (GAD) is a mental health condition that causes dread, worry, and overwhelm. Excessive, persistent, and unreasonable concern over everyday events characterizes it.
https://bit.ly/3Jmoj5R
Obsessive compulsive disorder(OCD)
Characterized by obsessional thoughts and compulsive rituals.
Secondary to both depressive illness and Gilles de la Tourette syndrome.
OCD is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry; by repetitive behaviours aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Fear The emotional response to real or perceived imminent
threat
Anxiety A feeling of apprehension or fear. The source of this is not always known or recognized
Phobias
Fear about a specific object or situation that is out of proportion
Agoraphobia Condition in which the patient fears places from
which escape might be dificult
Obsessive compulsive disorder(OCD)
Characterized by obsessional thoughts and compulsive rituals.
Secondary to both depressive illness and Gilles de la Tourette syndrome.
OCD is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear or worry; by repetitive behaviours aimed at reducing the associated anxiety; or by a combination of such obsessions and compulsions
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Fear The emotional response to real or perceived imminent
threat
Anxiety A feeling of apprehension or fear. The source of this is not always known or recognized
Phobias
Fear about a specific object or situation that is out of proportion
Agoraphobia Condition in which the patient fears places from
which escape might be dificult
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. What we will review
Epidemiology of anxiety and related disorders
Comorbid psychiatric diagnoses
Diagnostic criteria for anxiety and related
disorders
Neuroimaging findings of anxiety disorders
Quick questions to screen for anxiety disorders
Treatment including psychotherapy and
psychopharmacology
2
3. General considerations for anxiety
disorders
Often have an early onset- teens or early
twenties
Show 2:1 female predominance
Have a waxing and waning course over
lifetime
Similar to major depression and chronic
diseases such as diabetes in functional
impairment and decreased quality of life
3
4. Normal versus Pathologic Anxiety
Normal anxiety is adaptive. It is an inborn
response to threat or to the absence of
people or objects that signify safety .
can result in cognitive (worry) and somatic
(racing heart, sweating, shaking, freezing,
etc.) symptoms.
Pathologic anxiety is anxiety that is
excessive, impairs function.
4
5. Focused Neuroanatomy Review
Amygdala- involved with processing of
emotionally salient stimuli
Medial prefrontal cortex (includes the
anterior cingulate cortex, the subcallosal
cortex and the medial frontal gyrus)-
involved in modulation of affect
Hippocampus- involved in memory
encoding and retrieval
5
6. Primary versus Secondary Anxiety
Anxiety may be due to one of the primary
anxiety disorders OR secondary to
substance abuse (Substance-Induced
Anxiety Disorder), a medical condition
(Anxiety Disorder Due to a General
Medical Condition), another psychiatric
condition, or psychosocial stressors
(Adjustment Disorder with Anxiety)
6
7. Anxiety disorders
Specific phobia
Social anxiety
disorder (SAD)
Panic disorder (PD)
Agoraphobia
Generalized anxiety
disorder (GAD)
Anxiety Disorder due
to a General Medical
Condition . (Some of the
medical conditions that may be involved in this
disorder are hyperthyroidism, hypothyroidism,
hypoglycemia, and hyperadrenocorticism .
congestive heart failure and arrhythmia. Breathing
problems such as COPD, pneumonia, and
hyperventilation also can initiate anxiety)
Substance-Induced
Anxiety Disorder
Anxiety Disorder NOS
7
9. Genetic Epidemiology of
Anxiety Disorders
There is significant familial aggregation for
PD, GAD, OCD and phobias
Twin studies found heritability of 0.43 for
panic disorder and 0.32 for GAD.
9
11. Specific Phobia
Marked or persistent fear (>6 months) that is
excessive or unreasonable cued by the
presence or anticipation of a specific object or
situation
Anxiety must be out of proportion to the actual danger
or situation
It interferes significantly with the persons routine or
function
11
12. Specific Phobia
Epidemiology
Up to 15% of general population
Onset early in life
Female:Male 2:1
Etiology
Learning, contextual conditioning
Treatment
Systematic desensitization
12
14. Social Anxiety Disorder (SAD)
Marked fear of one or more social or performance
situations in which the person is exposed to the possible
scrutiny of others and fears he will act in a way that will
be humiliating
Exposure to the feared situation almost invariably
provokes anxiety
Anxiety is out of proportion to the actual threat posed by
the situation
The anxiety lasts more than 6 months
The feared situation is avoided or endured with distress
The avoidance, fear or distress significantly interferes
with their routine or function
14
15. SAD epidemiology
7% of general population
Age of onset teens; more common in
women. Stein found half of SAD patients
had onset of symptoms by age 13 and
90% by age 23.
Causes significant disability
Increased depressive disorders
15
16. Functional imaging studies in
SAD
Several studies have found hyperactivity
of the amygdala even with a weak form of
symptom provocation namely presentation
of human faces.
Successful treatment with either CBT or
citalopram showed reduction in activation
of amygdala and hippocampus
16
19. Panic Disorder
Recurrent unexpected panic attacks and
for a one month period or more of:
Persistent worry about having additional
attacks
Worry about the implications of the attacks
Significant change in behavior because of the
attacks
19
20. A Panic Attack is:
Palpitations or rapid
heart rate
Sweating
Trembling or
shaking
Shortness of breath
Feeling of choking
Chest pain or
discomfort
Nausea
Chills or heat
sensations
Paresthesias
Feeling dizzy or faint
Derealization or
depersonalization
Fear of losing
control or going
crazy
Fear of dying
A discrete period of intense fear in which 4 of the following
Symptoms abruptly develop and peak within 10 minutes:
20
21. Panic disorder epidemiology
2-3% of general population; 5-10% of
primary care patients ---Onset in teens or
early 20’s
Female:male 2-3:1
21
22. Things to keep in mind
A panic attack ≠ panic
disorder
Panic disorder often
has a waxing and
waning course
22
23. Panic Disorder Comorbidity
50-60% have lifetime major depression
One third have current depression
20-25% have history substance
dependence
23
27. Agoraphobia
Marked fear or anxiety for more than 6
months about two or more of the following
5 situations:
Using public transportation
Being in open spaces
Being in enclosed spaces
Standing in line or being in a crowd
Being outside of the home alone
27
28. Agoraphobia
The individual fears or avoids these situations
because escape might be difficult or help might
not be available
The agoraphobic situations almost always
provoke anxiety
Anxiety is out of proportion to the actual threat
posed by the situation
The agoraphobic situations are avoided or
endured with intense anxiety
The avoidance, fear or anxiety significantly
interferes with their routine or function
28
29. Prevalence
2% of the population
Females to males:2:1
Mean onset is 17 years
75% of persons with agoraphobia have
panic attacks or panic disorder
Increase higher risk of other anxiety
disorders, depressive and substance-use
disorders
29
31. Generalized Anxiety Disorder
Excessive worry more days than not for at
least 6 months about a number of events
and they find it difficult to control the worry.
3 or more of the following symptoms:
Restlessness or feeling keyed up or on edge,
easily fatigued, difficulty concentrating,
irritability, muscle tension, sleep disturbance
Causes significant distress or impairment
31
33. GAD Comorbidity
90% have at least one other lifetime Axis I
Disorder
66% have another current Axis I disorder
Worse prognosis over 5 years than panic
disorder
33
34. GAD Treatment
Medications including buspirone (an agonist of the serotonin
5-HT1A receptor ), benzodiazepines, antidepressants
(SSRIs, venlafaxine, imipramine)
Cognitive-behavioral therapy
34
35. Obsessive-Compulsive and Related
Disorders
Obsessive-
Compulsive Disorder
Body Dysmorphic
Disorder
Hoarding Disorder
Trichotillomania (Hair
Pulling Disorder)
Excoriation (Skin
Picking) Disorder
35
36. Prevalence of Obsessive-
Compulsive Related Disorders
Body Dysmorphic Disorder-2.4%
9-15% of dermatologic pts
7% of cosmetic surgery pts
10% of pts presenting for oral or maxillofacial
surgery!
Hoarding Disorder- est. 2-6% F<M
Trichotillomania 1-2% F:M 10:1!
Excoriation Disorder 1.4% F>M
36
38. Obsessive-Compulsive Disorder
(OCD)
Obsessions defined by:
recurrent and persistent thoughts, impulses or
images that are intrusive and unwanted that cause
marked anxiety or distress
The person attempts to ignore or suppress such
thoughts, urges or images, or to neutralize them
with some other thought or action (i.e. compulsion)
Obsessions or compulsions or both defined by:
38
39. OCD continued
Compulsions as defined by:
Repetitive behaviors or mental acts that the
person feels driven to perform in response to
an obsession or according to rigidly applied
rules.
The behaviors or acts are aimed at reducing
distress or preventing some dreaded situation
however these acts or behaviors are not
connected in a realistic way with what they
are designed to neutralize or prevent.
39
40. OCD continued
The obsessions or compulsions cause
marked distress, take > 1 hour/day or
cause clinically significant distress or
impairment in function
Specify if:
With good or fair insight- recognizes beliefs are
definitely or most likely not true
With poor insight- thinks are probably true
With absent insight- is completely convinced the
COCD beliefs are true
Tic- related 40
41. OCD Epidemiology
2% of general
population
Mean onset 19.5
years, 25% start by
age 14! Males have
earlier onset than
females
Female: Male 1:1
41
42. OCD Comorbidities
>70% have lifetime dx
of an anxiety disorder
such as PD, SAD,
GAD, phobia
>60% have lifetime dx
of a mood disorder
MDD being the most
common
Up to 30% have a
lifetime Tic disorder
12% of persons with
schizophrenia/
schizoaffective
disorder
42
44. Functional imaging studies
Increased activity in the right caudate is
found in pts with OCD and Cognitive
behavior therapy reduces resting state
glucose metabolism or blood flow in the
right caudate in treatment responders.
Similar results have been obtained with
pharmacotherapy
44
46. Crank up the serotonin
Cornerstone of treatment for anxiety
disorders is increasing serotonin
Any of the SSRIs or SNRIs can be used
46
47. How to use them
Start at ½ the usual dose used for
antidepressant benefit i.e citalopram at
10mg rather than the usual 20mg
WARN THEM THEIR ANXIETY MAY GET
WORSE BEFORE IT GETS BETTER!!
May need to use an anxiolytic while
initiating and titrating the antidepressant
47
48. Other options
Buspirone-For GAD- 60mg daily
Propranolol-Effective for discrete social
phobia i.e. performance anxiety
Atypical antipsychotics at low doses for
augmentation in difficult to treat OCD pts
48
49. Anticonvulsants
Valproic acid 500-750 mg bid (ending
dose)
carbamazepine 200-600 mg bid (ending
dose)
Gabapentin 900-2700 mg daily in 3
divided doses (ending dose)
Atypical antipsychotics at low doses for
augmentation in difficult to treat OCD pts
49
50. Mothers little helpers
Benzodiazapines are very effective in reducing
anxiety sx however due to the risk of
dependence must use with caution
Depending on the patient may either use on a
prn basis or scheduled
DO NOT USE ALPRAZOLAM- talk about a
reinforcing drug!
For patients with a history of addiction or active
drug/ETOH abuse or dependence
benzodiazepines are not an option
50
52. Take home points
Anxiety, Obsessive-Compulsive and Related,
and Trauma and Stressor-related disorders are
common, common, common!
There are significant comorbid psychiatric
conditions associated with anxiety disorders!
Screening questions can help identify or rule out
diagnoses
There are many effective treatments including
psychotherapy and psychopharmacology
There is a huge amount of suffering associated
with these disorders!
52