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1.
Psychiatr Danub ; 32(Suppl 1): 139-141, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890377

RESUMO

In this brief report we present the case of a 53 year old man with a very debilitating Generalized Anxiety Disorder successfully treated with tranylcypromine. After several failed treatment attempts following international guidelines recommendations over the course of one year and a half, tranylcypromine was prescribed which led to effective and sustained remission of anxiety symptoms for this patient. We also briefly explore treatment options for resistant cases of generalized anxiety disorder, given the major negative impacts of untreated GAD in a person's daily functioning and quality of life.


Assuntos
Transtornos de Ansiedade , Inibidores da Monoaminoxidase , Qualidade de Vida , Ansiedade , Transtornos de Ansiedade/tratamento farmacológico , Quimioterapia Combinada , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Monoaminoxidase/uso terapêutico
2.
Medicine (Baltimore) ; 99(39): e22274, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991427

RESUMO

BACKGROUND: Anxiety is the most common mental illness among adolescents and children, and its incidence is increasing year by year, which has a serious adverse effect on the academic and growth of adolescents and children. Conventional treatment methods such as oral administration of western medicine and psycho-behavioral therapy have obvious limitations. Chinese patent medicines play an irreplaceable role in the treatment of this disease. At present, there is no comparison of the safety and effectiveness of various Chinese patent medicines curing anxiety in adolescents. So we take advantage of the method of network meta-analysis to systematically compare the efficacy of various Chinese patent medicines curing this disease. METHODS: We will systematically and comprehensively search the following databases, including PubMed, Web of Science, EMBASE, The Cochrane Library, China BioMedical Literature (CBM), China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), and Wanfang database. We will include all RCT trials that meet the inclusion criteria, starting from the establishment of the database until August 2020. Two researchers will independently screen the literature based on inclusion criteria. While extracting data, we also assess the risk of bias in the included studies. All the data and evidence obtained will be evaluated by the method of Bayesian network meta-analysis. STATA and WinBUGS software will be used. RESULTS: This study will evaluate the effectiveness and safety of various TCPMs for anxiety disorders in children or adolescence. CONCLUSION: The results of this study will provide valuable references for the clinical application of Traditional Chinese patent medicines, and assist clinicians in formulating more reasonable diagnosis and treatment strategies. ETHICS AND DISSEMINATION: This study does not require ethical approval. INPLASY REGISTRATION NUMBER: INPLASY202080048.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Medicina Tradicional Chinesa/métodos , Medicamentos sem Prescrição/uso terapêutico , Adolescente , Teorema de Bayes , Criança , Protocolos Clínicos/normas , Humanos , Metanálise em Rede , Medicamentos sem Prescrição/administração & dosagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento
3.
Artigo em Inglês | MEDLINE | ID: mdl-32942345

RESUMO

Background: There is a paucity of studies on treatment of childhood-onset bipolar disorder and its associated comorbidities, which leads to a wide diversity of opinion on choice and sequencing of treatment options. Methods: From December 2018 to January 2019, a graphic depiction of medications and weekly ratings of symptoms of mania, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), and oppositional behavior that parents had rated on their 9-year-old child over a period of several years was sent to experts in child and adult bipolar disorder. These responding medical doctors (MDs, 8 child and 18 adult psychiatrists) rated a comprehensive list of medications that they would choose (and with what priority) to treat the child's now improved mood (mania and depression) but continued mild to moderate symptoms of anxiety, ADHD, and oppositional behavior. Results: In the whole group, the drugs most highly endorsed were lamotrigine: 69%, lithium: 62%, lurasidone: 62%, quetiapine: 54%, aripiprazole: 46%, and valproate: 42%. Among the antidepressants, 38% endorsed a selective serotonin reuptake inhibitor, 12% a serotonin-norepinephrine reuptake inhibitor, and 27% bupropion. Of the child MDs, 75% suggested increasing the 1-mg dose of risperidone, while few adult MDs suggested this. Conversely, 56% of the adult MDs suggested using valproate, while only 1 child MD did so. There was little consensus on how to manage ADHD symptoms unresponsive to methylphenidate 36 mg/d. How these treatment options were sequenced also varied widely. Conclusions: There was wide variation in suggestions on to how to treat persistent symptoms of anxiety, ADHD, and oppositional behavior in a child whose mania and depression had been brought under good control. We surmise that this great diversity in recommendations among experts in child and adult bipolar disorder stems at least partially from inadequate literature on treatment and that a new emphasis on funding and conducting studies on efficacy and effectiveness is needed.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/tratamento farmacológico , Transtorno Bipolar/tratamento farmacológico , Psicotrópicos/uso terapêutico , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno Bipolar/terapia , Criança , Consenso , Feminino , Humanos , Prevenção Primária , Indução de Remissão
5.
Encephale ; 46(3S): S93-S98, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32507556

RESUMO

Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pandemias , Transtorno de Pânico/psicologia , Pneumonia Viral/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Catastrofização , Comorbidade , Infecções por Coronavirus/epidemiologia , Dispneia/etiologia , Dispneia/psicologia , Feminino , Humanos , Hipopotassemia/etiologia , Masculino , Transtorno de Pânico/tratamento farmacológico , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/fisiopatologia , Pneumonia Viral/epidemiologia , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Sistema Renina-Angiotensina/fisiologia , Respiração/efeitos dos fármacos , Estresse Psicológico/etiologia , Estresse Psicológico/fisiopatologia , Terminologia como Assunto , Torsades de Pointes/induzido quimicamente , Torsades de Pointes/etiologia
6.
Pediatrics ; 146(1)2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499386

RESUMO

BACKGROUND: Benzodiazepines are commonly prescribed to treat anxiety disorders and have been associated with falls and fractures in older adults. It is unknown whether benzodiazepines increase fracture risk in youth. We examined whether youth with anxiety disorders initiating benzodiazepine treatment have an increased risk of fractures compared with youth initiating selective serotonin reuptake inhibitors (SSRIs). METHODS: We used claims from commercially insured children (6-17 years) and young adults (18-24) with a recent anxiety disorder diagnosis, initiating benzodiazepines or SSRIs (2008-2016). Youth were followed until fracture, treatment discontinuation or switching, disenrollment, 3 months, or December 31, 2016. The primary end point was diagnostic codes for upper and lower limb fractures. Incident fracture rates, incident rate ratios (IRRs), and incident rate differences (IRDs) were estimated with propensity score inverse probability of treatment weighting. RESULTS: The cohort included 120 715 children and 179 768 young adults. In children, crude fracture rates during treatment were 33.1 per 1000 person-years (PYs) for benzodiazepine initiators and 25.1 per 1000 PYs for SSRI initiators. Adjusted IRR and IRD were 1.53 (95% confidence interval [CI]: 0.94-2.50) and 13.4 per 1000 PYs. Risk was heightened in children initiating long-acting benzodiazepines versus SSRIs (adjusted IRR = 2.30 [95% CI: 1.08-4.91]). Fracture rates were lower in young adults, with minimal differences between treatments (adjusted IRR = 0.85 [95% CI: 0.57-1.27]; adjusted IRD = -1.3 per 1000 PYs). CONCLUSIONS: An increased rate of fractures in children, but not young adults, with anxiety disorders initiating benzodiazepine treatment compared to SSRI treatment suggests a need for increased caution in the weeks after benzodiazepine initiation in children.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Benzodiazepinas/efeitos adversos , Fraturas Ósseas/induzido quimicamente , Fraturas Ósseas/epidemiologia , Inibidores de Captação de Serotonina/efeitos adversos , Adolescente , Benzodiazepinas/uso terapêutico , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Medição de Risco , Inibidores de Captação de Serotonina/uso terapêutico , Adulto Jovem
7.
Orv Hetil ; 161(15): 594-600, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32323963

RESUMO

Introduction: Anxiolytic drug dependence is a cause for growing concern worldwide including Hungary. Psychiatric patients and patients with other drug addictions are at increased risk for anxiolytic drug dependence. Yet, there is only limited scientific information about the real extent of this issue. Aim: To examine the frequency of use of benzodiazepine-containing drugs and comparing the consumption habits of patients treated in psychiatric and addiction rehabilitation wards in a hospital in Budapest. Method: The survey was based on an anonymously and voluntarily completed questionnaire during a face-to-face interview of 103 patients in two wards. The 19-item questionnaire targeted anxiolytic drug use and related behavioral patterns. Statistical analysis: Socio-demographic data were given with means and standard deviations or with percentages as appropriate. For the comparison between the two groups of patients, t-test, Mann­Whitney U-test or chi-square test were used in accordance with the distribution of the sample. Results: Symptoms indicating anxiolytic dependence, use of multiple anxiolytics, and combination of anxiolytic drugs with alcohol were very frequent in both wards. However, there were some significant differences between the two samples. Anxiolytic drug abuse and illicit drug use were significantly more frequent in patients at the addiction ward. Indicators of social status, particularly the place of residence, significantly influenced non-prescription misuse of anxiolytic drugs. Conclusions: The results draw attention to the high frequency of anxiolytic drug misuse and dependence in psychiatric and addiction patients warranting urgent action to confront this challenge. Orv Hetil. 2020; 161(15): 594­600.


Assuntos
Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Hipnóticos e Sedativos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/complicações , Ansiolíticos/efeitos adversos , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Humanos , Hungria , Hipnóticos e Sedativos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Inquéritos e Questionários
8.
Nat Med ; 26(5): 760-768, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32231295

RESUMO

The National Institute of Mental Health (NIMH) 'fast-fail' approach seeks to improve too-often-misleading early-phase drug development methods by incorporating biomarker-based proof-of-mechanism (POM) testing in phase 2a. This first comprehensive application of the fast-fail approach evaluated the potential of κ-opioid receptor (KOR) antagonism for treating anhedonia with a POM study determining whether robust target engagement favorably impacts the brain circuitry hypothesized to mediate clinical effects. Here we report the results from a multicenter, 8-week, double-blind, placebo-controlled, randomized trial in patients with anhedonia and a mood or anxiety disorder (selective KOR antagonist (JNJ-67953964, 10 mg; n = 45) and placebo (n = 44)). JNJ-67953964 significantly increased functional magnetic resonance imaging (fMRI) ventral striatum activation during reward anticipation (primary outcome) as compared to placebo (baseline-adjusted mean: JNJ-67953964, 0.72 (s.d. = 0.67); placebo, 0.33 (s.d. = 0.68); F(1,86) = 5.58, P < 0.01; effect size = 0.58 (95% confidence interval, 0.13-0.99)). JNJ-67953964, generally well tolerated, was not associated with any serious adverse events. This study supports proceeding with assessment of the clinical impact of target engagement and serves as a model for implementing the 'fast-fail' approach.


Assuntos
Anedonia/efeitos dos fármacos , Benzamidas/uso terapêutico , Transtornos do Humor/tratamento farmacológico , Antagonistas de Entorpecentes/uso terapêutico , Pirrolidinas/uso terapêutico , Receptores Opioides kappa/antagonistas & inibidores , Adulto , Transtornos de Ansiedade/complicações , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/psicologia , Fármacos do Sistema Nervoso Central/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/complicações , Transtornos do Humor/psicologia , Estudo de Prova de Conceito , Fatores de Tempo , Resultado do Tratamento
11.
Gene ; 739: 144513, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32112986

RESUMO

Alprazolam is used in the treatment of patients with anxiety disorders comorbid with alcohol use disorder. Some proportion of these patients does not respond adequately to treatment with alprazolam, while many of them experience dose-dependent adverse drug reactions. Results of the previous studies have shown that CYP3A is involved in the biotransformation of alprazolam, the activity of which is dependent, inter alia, on the polymorphism of the encoding gene. OBJECTIVE: The objective of our study was to investigate the effect of 99366316G>A polymorphism of the CYP3A4 gene on the concentration/dose indicator of alprazolam in patients with anxiety disorders comorbid with alcohol use disorder, using findings on enzymatic activity of CYP3A (as evaluated by the 6-beta-hydroxy-cortisol/cortisol ratio measurement) and on CYP3A4 expression level obtained by measuring the miR-27b plasma concentration levels in patients with anxiety disorders comorbid with alcoholism. MATERIAL AND METHODS: Our study enrolled 105 patients with anxiety disorders comorbid with alcohol use disorder (age - 37.8±14.6 years). Therapy included alprazolam in an average daily dose of 5.6±2.4 mg per day. Treatment efficacy was evaluated using the psychometric scales. Therapy safety was assessed using the UKU Side-Effect Rating Scale. For genotyping and estimation of the microRNA (miRNA) plasma levels, we performed the real-time polymerase chain reaction. The activity of CYP3A was evaluated using the HPLC-MS/MS method by the content of the endogenous substrate of the given isoenzyme and its metabolite in urine (6- beta-hydroxy-cortisol/cortisol). Therapeutic drug monitoring (TDM) has been performed using HPLC-MS/MS. RESULTS: Our study revealed the statistically significant results in terms of the treatment efficacy evaluation (HAMA scores at the end of the treatment course): (GG) 3.0 [2.0; 5.0] and (GA) 4.0 [4.0; 5.0], p = 0.007; at the same time, the statistical significance in the safety profile was not obtained (the UKU scores): (GG) 3.0 [2.0; 3.8] and (GA) 3.0 [1.5; 4.0], p = 0.650. We revealed a statistical significance for concentration/dose indicator of alprazolam in patients with different genotypes: (GG) 1.583 [0.941; 2.301] and (GA) 2.888 [2.305; 4.394], p = 0.001). Analysis of the results of the pharmacotranscriptomic part of the study didn't show the statistically significant difference in the miR-27b plasma levels in patients with different genotypes: (GG) 25.6 [20.4; 28.8], (GA) 25.7 [19.7; 33.1], p = 0.423. At the same time, correlation analysis revealed a statistically significant relationship between the alprazolam efficacy profile evaluated by changes in HAMA scale scores and the miR-27b plasma concentration: rs = 0.20, p = 0.042. Also, we didn't reveal the correlation between the miRNA concentration and safety profile: rs = 0.15, p = 0.127. In addition, we revealed the relationship between the CYP3A enzymatic activity (as evaluated by 6-beta-hydroxycortisol/ cortisol ratio measurement) and the miR-27b plasma concentration: rs = -0.27, p = 0.006. At the same time, correlation analysis revealed a statistically significant relationship between the alprazolam concentration and the miR-27b plasma concentration: rs = 0.28, p = 0.003. CONCLUSION: The effect of genetic polymorphism of the CYP3A4 gene on the efficacy and safety profiles of alprazolam was demonstrated in a group of 105 patients with anxiety disorders comorbid with alcohol use disorder. At the same time, miR-27b remains a promising biomarker for assessing the level of CYP3A4 expression, because it correlates with the encoded isoenzyme's activity.


Assuntos
Alcoolismo/tratamento farmacológico , Alprazolam/farmacocinética , Transtornos de Ansiedade/tratamento farmacológico , Citocromo P-450 CYP3A/genética , MicroRNAs/sangue , Polimorfismo Genético/genética , Adulto , Alprazolam/sangue , Biomarcadores/sangue , Biotransformação , Comorbidade , Citocromo P-450 CYP3A/sangue , Genótipo , Humanos , Isoenzimas , Masculino , MicroRNAs/genética , Pessoa de Meia-Idade , Farmacogenética , Medicina de Precisão , Resultado do Tratamento , Adulto Jovem
12.
Am J Gastroenterol ; 115(6): 853-858, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195733

RESUMO

OBJECTIVES: The prevalence of psychiatric disease in patients with eosinophilic esophagitis (EoE) is not fully characterized. We aimed to determine the prevalence of psychiatric disease and centrally acting medication use in a cohort of children and adults with EoE and evaluated whether psychiatric disease affects the EoE clinical presentation. METHODS: We conducted a retrospective study of newly diagnosed cases with EoE at the University of North Carolina from 2002 to 2018. Psychiatric comorbidities and relevant treatments were extracted from the medical records. The demographic and clinical features of patients with EoE with and without psychiatric diagnoses, and those with and without psychiatric medication use, were compared. RESULTS: Of 883 patients (mean age 26.6 years, 68% men, 79% white), 241 (28%) had a psychiatric comorbidity. The most common diagnosis was anxiety (23%) followed by depression (17%); 28% of patients were treated pharmacologically. There were 45 patients (5%) treated pharmacologically without a psychiatric diagnosis for chronic pain syndromes, insomnia, and/or epilepsy. Cases with EoE with a psychiatric diagnosis were more likely to be women, white, and 18 years or older and to have a longer symptom duration before diagnosis. DICUSSION: Psychiatric comorbidities were common in EoE, seen in a third of adults and more than 1 in 7 children, and with similar proportions receiving a prescription medication. These illnesses affected the EoE presentation because psychiatric comorbidities were more likely in older, female, and white patients with a longer duration of symptoms preceding diagnosis.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Depressivo/epidemiologia , Esofagite Eosinofílica/epidemiologia , Psicotrópicos/uso terapêutico , Adolescente , Adulto , Distribuição por Idade , Transtornos de Ansiedade/tratamento farmacológico , Benzodiazepinas/uso terapêutico , Dor no Peito/fisiopatologia , Criança , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Comorbidade , Transtornos de Deglutição/fisiopatologia , Transtorno Depressivo/tratamento farmacológico , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/fisiopatologia , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Feminino , Gabapentina/uso terapêutico , Azia/fisiopatologia , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Convulsões/tratamento farmacológico , Convulsões/epidemiologia , Inibidores de Captação de Serotonina/uso terapêutico , Distribuição por Sexo , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológico , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Adulto Jovem
13.
BMC Complement Med Ther ; 20(1): 70, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143600

RESUMO

BACKGROUND: Post-traumatic stress disorder (PTSD) is an extreme mood disorder that occurs after experiencing extreme stress, and patients with this disorder are known to accompany with symptoms of depression, anxiety, and memory impairments. Silibinin (SIL) is a natural polyphenolic flavonoid and is the main active ingredient of silymarin, which is primarily extracted from the milk thistle. Although some studies have assessed the properties of this flavonoid, the potential of SIL as a treatment for PTSD patients and its mechanisms of action have yet to be fully elucidated. METHODS: After exposure to a model of single prolonged stress (SPS), the open field test (OFT) and forced swimming test (FST), were used to investigate the effects of SIL on anxiety- and depression-like symptoms in male rats. The rats received of SIL (25, 50, and 100 mg/kg) for 14 days following exposure to SPS. RESULTS: Administration of SIL significantly improved anxiety-like behaviors in the OFT, depression-like behaviors in the FST, and freezing behavior in fear conditioning test. SIL also increased levels of serotonin in the hippocampus (Hipp) and amygdala, and enhanced expression of tryptophan hydroxylase-1 mRNA in the Hipp. The administration of SIL also inhibited SPS-induced decreases dopamine levels and increases norepinephrine levels in the Hipp. CONCLUSIONS: Taken together, the present findings suggest that SIL can be a useful therapeutic ingredient for the treatment of trauma stress-associated symptoms, including PTSD-induced anxiety and depression caused by PTSD.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Transtorno Depressivo/tratamento farmacológico , Silimarina/farmacologia , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Animais , Transtornos de Ansiedade/prevenção & controle , Transtorno Depressivo/prevenção & controle , Masculino , Ratos , Ratos Sprague-Dawley , Serotonina/metabolismo
14.
Adv Exp Med Biol ; 1191: 347-365, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002937

RESUMO

Anxiety disorders, including panic disorder/agoraphobia (PDA), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and others, are the most prevalent mental disorders. In this paper, recommendations are given for the psychopharmacological treatment of these disorders which are based on comprehensive treatment guidelines, meta-analyses, and systematic reviews of available randomized controlled studies. Anxiety disorders can effectively be treated with psychotherapy, pharmacotherapy, or a combination of both. First-line drugs are the selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Benzodiazepines are not recommended for routine use due to their possible addiction potential. Other treatment options include the calcium modulator pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. Drug treatment can be combined with psychological treatments. Novel treatment strategies include medications that act on GABA, glutamate, and other neurotransmitter systems. After remission, medications should be continued for 6 to 12 months.


Assuntos
Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Humanos , Psicoterapia
15.
Adv Exp Med Biol ; 1191: 121-140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002926

RESUMO

Discovery of innovative anxiolytics is severely hampering. Existing anxiolytics are developed decades ago and are still the therapeutics of choice. Moreover, lack of new drug targets forecasts a severe jeopardy in the future treatment of the huge population of CNS-diseased patients. We simply lack the knowledge on what is wrong in brains of anxious people (normal and diseased). Translational research, based on interacting clinical and preclinical research, is extremely urgent. In this endeavor, genetic and genomic approaches are part of the spectrum of contributing factors. We focus on three druggable targets: serotonin transporter, 5-HT1A, and GABAA receptors. It is still uncertain whether and how these targets are involved in normal and diseased anxiety processes. For serotonergic anxiolytics, the slow onset of action points to indirect effects leading to plasticity changes in brain systems leading to reduced anxiety. For GABAA benzodiazepine drugs, acute anxiolytic effects are found indicating primary mechanisms directly influencing anxiety processes. Close translational collaboration between fundamental academic and discovery research will lead to badly needed breakthroughs in the search for new anxiolytics.


Assuntos
Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/fisiopatologia , Ansiedade/fisiopatologia , Descoberta de Drogas , Neurotransmissores/metabolismo , Pesquisa Médica Translacional , Ansiolíticos/farmacologia , Ansiedade/tratamento farmacológico , Ansiedade/metabolismo , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/metabolismo , Humanos
16.
Adv Exp Med Biol ; 1191: 169-184, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002929

RESUMO

This chapter describes the various animal models that seem relevant to the development of anxiolytic drugs, as well as the human models of induced anxiety, or more precisely the panic inducers including cholecystokinin. It is also mentioned the theoretical model of Deakin and Graeff which seems to keep all its relevance. The knock animals are evoked as relevant tools as well as a new optogenetic technique that needs to be used in this field.


Assuntos
Ansiolíticos , Transtornos de Ansiedade/tratamento farmacológico , Transtornos de Ansiedade/psicologia , Ansiedade/tratamento farmacológico , Ansiedade/psicologia , Modelos Animais de Doenças , Descoberta de Drogas , Animais , Ansiolíticos/farmacologia , Ansiolíticos/uso terapêutico , Colecistocinina/efeitos adversos , Humanos , Optogenética
17.
Adv Exp Med Biol ; 1191: 367-388, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32002938

RESUMO

This chapter reviews the role of benzodiazepines (BZs) in the treatment of anxiety disorders, specifically panic disorder with or without agoraphobia, generalized anxiety disorder, and social anxiety disorder (social phobia). BZs pharmacology, classification, efficacy, adverse effects, withdrawal symptoms, possible dependence, and abuse; their positioning among pharmacological treatment; and guidance on how to use them are discussed.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Benzodiazepinas/uso terapêutico , Agorafobia/complicações , Agorafobia/tratamento farmacológico , Transtornos de Ansiedade/complicações , Humanos , Transtorno de Pânico/complicações , Transtorno de Pânico/tratamento farmacológico
19.
Arch. Clin. Psychiatry (Impr.) ; 47(1): 19-24, Jan.-Feb. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1088743

RESUMO

Abstract Background Sleep disorders are common in psychiatric diseases. Panic disorder (PD) and generalized anxiety disorder (GAD) are two major anxiety disorders that are associated with sleep disorders. Objective We hypothesized that poor sleep quality continues in PD and GAD during remission. Therefore, in this study we aimed to compare the sleep quality of patients with PD and GAD to that of healthy controls. Methods The study included patients with PD (n = 42) and GAD (n = 40) who had been in remission for at least 3 months and healthy control volunteers (n = 45). The patients were administered the Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Results The total PSQI scores of the GAD group were significantly increased in comparison to those of the PD (p = 0.009) and control (p < 0.001) groups. The rate of poor sleep quality in GAD during remission (77.5%) was greater than that of the PD (47.6%) and control (51.1%) groups (p = 0.011). Discussion GAD is a chronic and recurrent disease. In this study, it was found that the deterioration in sleep quality of patients with GAD may continue during remission. In the follow-up and treatment of patients, it is appropriate to question about sleep symptoms and to plan interventions according to these symptoms.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos de Ansiedade/complicações , Transtornos do Sono-Vigília/etiologia , Qualidade do Solo , Transtorno de Pânico/complicações , Transtornos de Ansiedade/tratamento farmacológico , Tabagismo/psicologia , Estudos de Casos e Controles , Estudos Transversais , Transtorno de Pânico/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Intervalo Livre de Doença , Inibidores da Recaptação de Serotonina e Norepinefrina/uso terapêutico , Questionário de Saúde do Paciente
20.
J Stud Alcohol Drugs ; 81(1): 115-118, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32048609

RESUMO

OBJECTIVE: In academic settings around the world, there is a resurgence of interest in using psychedelic substances for the treatment of addictions, posttraumatic stress disorder, depression, anxiety, and other diagnoses. This case series describes the medical consequences of accidental overdoses in three individuals. METHOD: Case series of information were gathered from interviews, health records, case notes, and collateral reports. RESULTS: The first case report documents significant improvements in mood symptoms, including reductions in mania with psychotic features, following an accidental lysergic acid diethylamide (LSD) overdose, changes that have been sustained for almost 20 years. The second case documents how an accidental overdose of LSD early in the first trimester of pregnancy did not negatively affect the course of the pregnancy or have any obvious teratogenic or other negative developmental effects on the child. The third report indicates that intranasal ingestion of 550 times the normal recreational dosage of LSD was not fatal and had positive effects on pain levels and subsequent morphine withdrawal. CONCLUSIONS: There appear to be unpredictable, positive sequelae that ranged from improvements in mental illness symptoms to reduction in physical pain and morphine withdrawal symptoms. Also, an LSD overdose while in early pregnancy did not appear to cause harm to the fetus.


Assuntos
Transtornos de Ansiedade/tratamento farmacológico , Overdose de Drogas/diagnóstico , Alucinógenos/efeitos adversos , Dietilamida do Ácido Lisérgico/efeitos adversos , Dor/tratamento farmacológico , Adolescente , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/psicologia , Overdose de Drogas/psicologia , Feminino , Alucinógenos/uso terapêutico , Humanos , Dietilamida do Ácido Lisérgico/uso terapêutico , Pessoa de Meia-Idade , Dor/diagnóstico , Dor/psicologia , Gravidez , Adulto Jovem
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