RESUMO
Treatment guidelines which are available are intended for treatment of medically healthy patients. There is little information in the literature regarding the treatment of patients who are medically ill. Anxiety and anxiety disorders are frequently encountered in patients with serious medical disorders. These medically ill patients may have substantial changes in pharmacokinetic factors as a result of their current illness or treatment. Also, treatment considerations related to their accompanying medical treatment(s) are sometimes required. These various factors may result in a different initial choice of agents, alterations in the dosage of a given agent, or even preclude the use of some standard agents. In this chapter, we first present a review of the current psychopharmacologic treatment of anxiety disorders. In the second section, we review the potential pharmacokinetic consequences of serious hepatic renal, pulmonary and cardiac disease relevant to the pharmacological treatment of anxiety.
Assuntos
Ansiolíticos/uso terapêutico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Ansiedade/tratamento farmacológico , Doença/psicologia , Ansiolíticos/farmacocinética , Anticonvulsivantes/farmacocinética , Antidepressivos/farmacocinética , Ansiedade/etiologia , Ansiedade/metabolismo , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/metabolismo , Sistema Enzimático do Citocromo P-450/metabolismo , Interações Medicamentosas , HumanosAssuntos
Acetatos/efeitos adversos , Aminas , Anticonvulsivantes/efeitos adversos , Ácidos Cicloexanocarboxílicos , Ejaculação/efeitos dos fármacos , Orgasmo/efeitos dos fármacos , Disfunções Sexuais Psicogênicas/induzido quimicamente , Ácido gama-Aminobutírico , Acetatos/uso terapêutico , Adulto , Anticonvulsivantes/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Gabapentina , Humanos , Masculino , Disfunções Sexuais Fisiológicas/induzido quimicamenteRESUMO
BACKGROUND: Intense anger, easy irritability, and low frustration tolerance are frequently encountered in clinical practice and may occur as part of the constellation of symptoms associated with a number of Axis I and Axis II diagnoses. Recent studies have suggested the efficacy of fluoxetine in treating anger in depressed and borderline patients. The present study examines the treatment of anger as a target symptom regardless of accompanying psychopathology. METHOD: In this preliminary trial, 11 subjects experiencing intense anger were treated in an open-label fashion with fluoxetine over an 8-week period. Anger was measured by a clinician-administered Clinical Global Impressions-Severity (CGI-S) scale and a self-report anger inventory, the Multidimensional Anger Inventory (MAI). The Hamilton Rating Scale for Depression was administered at baseline and final visits. RESULTS: All 11 enrolled patients completed the study, and all patients demonstrated clinical improvement as measured by both the CGI-S and the MAI. Nine patients were rated as responders and 2 as nonresponders according to prospectively established criteria. Fluoxetine was well tolerated and showed rapid onset of action. CONCLUSION: This study is limited by small sample size and nonblinded, open-label design, but nonetheless suggests that fluoxetine may be useful in moderating anger as it occurs as part of the symptomatology of a number of Axis I and Axis II disorders. Controlled studies are warranted.
