Anxiety Disorder
Mita Restinia, M.Farm Apt
OUTLINE
Definition
Type of Anxiety
Symptom
Diagnosis
Treatment
Definition
One of psychiatric disorders. Anxiety disorders include a constellation of
disorders in which anxiety and associated symptoms are irrational or
experienced at a level of severity that impairs functioning.
type of anxiety
Generalized anxiety disorder
Panic disorder
Social anxiety disorder
Posttraumatic stress disorder
Generalized anxiety disorder
The main features of generalized anxiety disorder are excessive anxiety and worry.
The patients suffer from somatic anxiety symptoms as well as from restlessness,
irritability, difficulty concentrating, muscle tension, sleep disturbances and being
easily fatigued.
Patient may express constant worry that the patient or a relative will shortly become
ill or have an accident.
Panic disorder
Panic disorder is
characterized by
recurrent panic
attacks.
Usually, the patient is
afraid that he has a
serious medical
condition such as
myocardial infarction.
palpitations,
sweating, trembling,
dyspnoea, choking
sensations, chest
pain, nausea,
abdominal distress,
dizziness, feeling of
unreality, fear of
dying, etc
Social anxiety disorder
This disorder is characterized
by marked, persistent, and
unreasonable fear of being
observed or evaluated
negatively by others in social
performance or interaction
situations
These situations include fear of
speaking in public, speaking to
unfamiliar people or being
exposed to possible scrutiny by
others.
Posttraumatic stress disorder
PTSD develops after a terrifying
ordeal that involved physical
harm or the threat of physical
harm.
The person who develops PTSD
may have been the one who
was harmed, the harm may
have happened to a loved one,
or the person may have
witnessed a harmful event that
happened to loved ones or
strangers.
Diagnosis
Symptoms
Physical and mental status examination
Appropriate laboratory test
Algorithm GAD Treatment
Algorithm Panic Disorder Treatment
Algorithm of Social Anxiety Disorder
Algorithm PTSD Treatment
Drug Choices for anxiety disorders
Jakarta (CGK) Soekarno Hatta
Categories of evidence and
Recommendation Grade
Bandelow et.al. Guidelines for the pharmacological treatment of anxiety disorder,…
Selective Serotonin Reuptake Inhibitor
SSRIs are indicated (first line)for the anxiety disorders and PTSD.
Although treatment with SSRIs is usually well tolerated, restlessness, jitteriness,
an increase in anxiety symptoms, insomnia or headache in the first days or
weeks of treatment may jeopardize compliance with treatment.
Lowering the starting dose of SSRIs may reduce this overstimulation. Other
side effects include nausea (and therefore the recommendation is to take
it after a meal), headache, fatigue and dizziness.
The anxiolytic effect may start with a delay of 2 – 4 weeks (in some cases up
to 6 or 8 weeks). Long term side effects include sexual dysfunctions and
weight gain.
Serotonin-nor epinephrine Reuptake
Inhibitor
The anti-anxiety effect of SNRIs may have a latency of 2 – 4 weeks.
Like SSRIs, at the beginning of treatment, side effects like nausea,
restlessness, insomnia or headache may pose a threat to compliance with
treatment.
Also, sexual dysfunctions, discontinuation syndromes, increased blood
pressure, and other adverse events have been reported.
Benzodiazepines
Benzodiazepines. The anxiolytic effect starts within minutes after oral or
parenteral application. For acute treatment and improvement occur in first
2 weeks.
In general, they have a good record of safety. Due to CNS depression,
benzodiazepine treatment may be associated with sedation, dizziness, and
prolonged reaction time.
Benzodiazepine Discontinuation
After BZs are abruptly discontinued, three events can occur:
Rebound symptoms are an immediate, but transient, return of original symptoms
with an increased intensity compared with baseline.
Recurrence or relapse is the return of original symptoms at the same intensity as
before treatment.
Withdrawal is the emergence of new symptoms and a worsening of preexisting
symptoms.
Discontinuation strategies include the following:
A 25% per week reduction in dosage until 50% of the dose is reached, then
dosage reduction by one-eighth every 4 to 7 days. If therapy exceeds 8
weeks, a taper over 2 to 3 weeks is recommended, but if duration of
treatment is 6 months, a taper over 4 to 8 weeks should ensue. Longer
durations of treatment may require a 2- to 4-month taper.
A BZ with a long elimination half-life (t1/2) (e.g., diazepam, clonazepam)
may be substituted for a drug with a short t1/2 (e.g., lorazepam,
oxazepam, alprazolam). The substituted drug should be given for several
weeks before gradual tapering begins.
Adjunctive use of imipramine, valproic acid, or buspirone can help to
reduce withdrawal symptoms during the BZ taper.
Pharmacokinetic of BZ
Drug Interaction
Nor-Pharmacologic Treatment
Cognitive Behaviour Therapy (CBT)
Psychotherapy
Meditasi
Yoga
Handbook of Pharmacotherapy Dipiro
Bandelow et.al. Guidelines for the pharmacological treatment of anxiety disorder,…
