Measuring change in patients following psychological and pharmacological interventions: Anxiety disorders.

Author(s):  
Paul Crits-Christoph ◽  
Mary Beth Connolly
2002 ◽  
Vol 24 (suppl 1) ◽  
pp. 74-80 ◽  
Author(s):  
Gerard JA Byrne

Anxiety disorders decline in prevalence with advancing age but remain more common than depressive disorders. They are often of late-onset and there is frequent comorbidity with depressive disorders and physical illness. While anxiety disorders in older people are likely to respond to the same non-pharmacological interventions that have been shown to work in younger people, there is currently little formal evidence of this. Although there is some evidence that the non-benzodiazepine anxiolytic medication, buspirone, is effective against late life anxiety symptoms, clinical trials in older people with rigorously diagnosed anxiety disorders are needed. An anxiety scale with demonstrated reliability and validity in older people is needed for screening for pathological anxiety and for measuring change in older patients undergoing treatment for anxiety disorders.


Author(s):  
Gerard Byrne

Anxiety symptoms and anxiety disorders are highly prevalent among older people, including among those with physical frailty and cognitive impairment. Clinicians are advised to consider the effects of prescribed medication and other substances, and the influence of general medical conditions, in the older person presenting with anxiety. Psychological treatments are recommended for older people with anxiety disorders of mild to moderate severity. These include relaxation training, exposure-based interventions, and cognitive behaviour therapy. Pharmacological interventions are in widespread use, although there is little evidence in support of the long-term use of either benzodiazepines or antipsychotics in older people with anxiety disorders. Instead, treatment with antidepressant medication is recommended.


Author(s):  
Antoine Douaihy ◽  
Meredith Spada ◽  
Nicole Bates ◽  
Julia Macedo ◽  
Jack M. Gorman

HIV practitioners are increasingly confronted with complex co-occurring medical and psychiatric disorders among their patients. Depressive and anxiety disorders are among the most commonly diagnosed in HIV-infected individuals and can complicate the overall management of HIV illness. Anxiety may be experienced as a symptom, as a manifestation of an anxiety disorder, as a consequence of HIV-associated or other illness, or as a result of one of its treatments. It can occur at any stage, from the realization of being at risk, to the anxiety about a possible symptom, to the time of HIV testing and the experience of HIV-associated stigma and discrimination, diagnosis, disclosure, illness progression, late- and end-stage illness, and dying. This chapter explores the complexities of anxiety as it relates to HIV and AIDS and discusses the prevalence, diagnosis, and assessment of anxiety disorders. The impact of anxiety on medical management of HIV is also addressed, including adherence to antiretroviral regimen, psychotherapeutic and pharmacological interventions, and coexisting medical and psychiatric disorders.


Author(s):  
Richard Shelton

Antidepressant medications are the most commonly used treatments for depression. However, sustained full remission with single antidepressant drugs is uncommon. This is why combination treatments with two different medications or medications plus psychotherapy are often required to produce full remission. There are several antidepressant classes with different proximal mechanisms of action. Yet, all currently available antidepressants appear to act via a narrow set of distal mechanisms, ultimately affecting the development of neural regulatory networks. Drugs increase the expression of neurotrophins such as brain-derived neurotrophic factor, which leads to neurogenesis and synapse formation, actions that evolve over extended periods. This may be why antidepressants effects are usually delayed. The actions on regulatory networks in brain yield benefits that extend beyond depression to anxiety disorders and other conditions.


e-Neuroforum ◽  
2017 ◽  
Vol 23 (4) ◽  
Author(s):  
Simone B. Sartori ◽  
Nicolas Singewald

AbstractDespite advances in the treatment of fear-, anxiety- and trauma-related disorders, a considerable proportion of patients shows only partial long-term therapeutic benefit with existing treatments. A promising option in improving therapy is speeding up and boosting the effect of exposure-based therapy (EBT) by pharmacological interventions. Here, we will discuss select examples of novel concepts in augmenting fear extinction, the central mechanisms of EBT. Based on accumulating knowledge from animal and human studies concerning the neurocircuitries and neurobiological mechanisms underlying successful fear extinction, diverse potential pharmacological targets have been identified to optimize the efficacy of fear extinction. We focus here on selected examples of these targets and present translational evidence for strengthening fear inhibitory learning by using L-DOPA and D-cycloserine. Furthermore, the potential of HDAC inhibitors and microRNAs (e. g. miR-144) as epigenetic targets, as well as neuropeptide S as a model substance with combined acute anxiolytic and extinction-facilitating properties are discussed. The presented mechanisms represent promising novel strategies that may be useful in the future for augmenting the efficacy and improving the acceptance of EBT in the treatment of anxiety disorders, although further work remains to be done in characterising the underlying modes of action and safety aspects.


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