Treatment of Anxiety Disorders

Depressive Disorders ◽

Behavioral Therapy ◽

Evidence Based ◽

Promising Practices ◽

The Core ◽

Core Components ◽

As with depressive disorders, the two most common treatments for anxiety are psychotropic medication and psychotherapy, either individually or in conjunction. Psychotherapy is often the preferred first line of treatment unless the youth is a danger to self or others or is significantly unable to function. This chapter provides an overview of the classes of antianxiety and antidepressant medications (i.e., selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, benzodiazepines) used for treating different anxiety disorders along with brief information on their side effects. Descriptions are provided of the core components of curriculum and non-curriculum evidence-based and promising practices, including child–parent psychotherapy, trauma-focused cognitive-behavioral therapy, and two computerized therapies. The chapter ends by revisiting the case studies from Chapter 7, reviewing the actual outcomes of the cases and posing questions to prompt further discussion.

Cognitive-Behavioral Group Therapy for Heterogeneous Anxiety and Mood Disorders in a Psychiatric Hospital Outpatient Clinic

Journal of Cognitive Psychotherapy ◽

10.1891/0889-8391.27.2.138 ◽

2013 ◽

Vol 27 (2) ◽

pp. 138-154 ◽

Cited By ~ 9

Author(s):

Lynndall Dwyer ◽

Sara Olsen ◽

Tian Po S. Oei

Keyword(s):

Quality Of Life ◽

Anxiety Disorders ◽

Mood Disorders ◽

Outcome Measures ◽

Depressive Disorders ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Cognitive Behavioral Group Therapy ◽

Group Cbt

Recent literature has shown that group cognitive-behavioral therapy (CBT) is effective for individuals with heterogeneous anxiety disorders. However, these studies have used a narrow range of outcome measures, and have not included global measures such as quality of life. In addition, heterogeneous mood disorders have not been well researched. The aim of this study was to replicate and extend on previous studies by assessing the effectiveness of group CBT treatment programs designed for use with heterogeneous anxiety or depressive disorders. Global outcome measures of quality of life and social functioning were assessed in addition to outcome measures of anxiety and mood symptoms. There were 173 patients who completed either group CBT for anxiety disorders or for depressive disorders. Symptom measures and quality of life measures were used to determine treatment effectiveness. Results demonstrated that the treatments were effective in reducing overall symptom severity and improving quality of life. Treatment gains were maintained to 12 month follow-up. However, the degree of change was considerably lower than that found in comparable trials with diagnostically homogenous samples. Overall, group CBT for heterogeneous diagnostic populations was effective but requires further investigation and refinement.

Excessive, uncontrollable worries

Child and Adolescent Psychiatry ◽

10.1093/med/9780197577479.003.0015 ◽

2021 ◽

pp. 119-128

Author(s):

Joseph A. Pereira

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Behavioral Therapy ◽

Muscle Tension ◽

Serotonin Reuptake Inhibitors ◽

Somatic Complaints ◽

Cognitive Behavioral ◽

Generalized Anxiety ◽

Generalized anxiety disorder (GAD) is characterized by excessive anxiety and worry that is difficult to control. The worry is accompanied by at least one of restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep disturbance. Anxiety may present with crying episodes, temper tantrums, and irritability in children. Compared to adults, youth are also more likely to report somatic complaints associated with anxiety such as gastrointestinal upset, headaches, and sweating. Psychotherapies for GAD include cognitive behavioral therapy (CBT) and parent guidance to decrease accommodating behaviors. Pharmacotherapy options include selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).

Recurrent episodes of intense fear, shortness of breath, racing heart, and sweating

Child and Adolescent Psychiatry ◽

10.1093/med/9780197577479.003.0014 ◽

2021 ◽

pp. 111-118

Author(s):

Christina L. Macenski

Keyword(s):

Panic Disorder ◽

Gold Standard ◽

Panic Attack ◽

Behavioral Therapy ◽

Panic Attacks ◽

Shortness Of Breath ◽

Intense Fear ◽

Therapy Intervention ◽

Panic disorder consists of recurrent, unexpected panic attacks accompanied by persistent worry about future attacks and/or a maladaptive change in behavior related to the attacks. A panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes that occurs in conjunction with several other associated symptoms such as palpitations, sweating, trembling, shortness of breath, and chest pain. Features of panic disorder that are more common in adolescents than in adults include less worry about additional panic attacks and decreased willingness to openly discuss their symptoms. All patients with suspected panic disorder should undergo a medical history, physical examination, and laboratory workup to exclude medical causes of panic attacks. Cognitive behavioral therapy (CBT) including interoceptive exposures is the gold standard therapy intervention. Medications including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can also help reduce symptoms.

How to Bend but Not Break an Empirically Supported Treatment for Anxiety in Youth

Flexibility within Fidelity ◽

10.1093/med-psych/9780197552155.003.0011 ◽

2021 ◽

pp. 175-210

Author(s):

Lara S. Rifkin ◽

Lindsay Myerberg ◽

Elizabeth A. Gosch ◽

Lesley A. Norris ◽

Margaret E. Crane ◽

...

Keyword(s):

Behavioral Therapy ◽

Developmental Level ◽

Empirically Supported Treatment ◽

The Core ◽

Empirically Supported ◽

Youth Anxiety ◽

Essential Components ◽

Self Talk ◽

Core Components ◽

Building Rapport

This chapter addresses the treatment of youth anxiety. Cognitive behavioral therapy (CBT) for youth anxiety, as illustrated by the Coping Cat program, is implemented flexibly based on considerations including age/developmental level, co-occurring disorders, socioeconomic status, and cultural factors to enhance outcomes. For fidelity, the program adheres to key components: building rapport, providing psychoeducation about anxiety, addressing anxious self-talk, conducting exposures, assigning homework, and providing rewards/praise. The essential components, however, are applied with flexibility. Ultimately, research is needed to evaluate strategies to increase continued fidelity to the core components of treatment. Peer consultation and supervision may be valuable for maintaining fidelity while flexibly applying the program to a specific client.

Antidepressant-induced jitteriness/anxiety syndrome: systematic review

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.048371 ◽

2009 ◽

Vol 194 (6) ◽

pp. 483-490 ◽

Cited By ~ 93

Author(s):

Lindsey I. Sinclair ◽

David M. Christmas ◽

Sean D. Hood ◽

John P. Potokar ◽

Andrea Robertson ◽

...

Keyword(s):

Side Effects ◽

Anxiety Disorders ◽

Time Course ◽

Rating Scales ◽

Antidepressant Treatment ◽

Incidence Rates ◽

Conclusive Evidence ◽

Response To Treatment ◽

Robust Evidence

BackgroundEarly worsening of anxiety, agitation and irritability are thought to be common among people commencing antidepressants, especially for anxiety disorders. This phenomenon, which may be termed jitteriness/anxiety syndrome, is cited as an explanation for early treatment failure and caution in using selective serotonin reuptake inhibitors (SSRIs). However, we believe that it is inconsistently defined and that robust evidence to support the phenomenon is lacking.AimsTo review systematically all evidence relating to jitteriness/ anxiety syndrome to identify: constituent symptoms; medications implicated; disorders in which it was reported; incidence; time course; management strategies; relationship of this syndrome to therapeutic response; distinction between syndrome and akathisia; relationship between syndrome and suicide; and genetic predispositions.MethodA systematic search identified articles and these were included in the review if they addressed one of the above aspects of jitteriness/anxiety syndrome.ResultsOf 245 articles identified, 107 articles were included for review. No validated rating scales for jitteriness/anxiety syndrome were identified. There was no robust evidence that the incidence differed between SSRIs and tricyclic antidepressants, or that there was a higher incidence in anxiety disorders. Published incidence rates varied widely from 4 to 65% of people commencing antidepressant treatment. Common treatment strategies for this syndrome included a slower titration of antidepressant and the addition of benzodiazepines. Conclusive evidence for the efficacy of these strategies is lacking. There was conflicting and inconclusive evidence as to whether the emergence of this syndrome had a predictive value on the response to treatment. It appears to be a separate syndrome from akathisia, but evidence for this assertion was limited. The effect of jitteriness/anxiety syndrome on suicide rates has not been evaluated. Three studies examined genetic variations and side-effects from treatment, but none was specifically designed to assess jitteriness/anxiety syndrome.ConclusionsJitteriness/anxiety syndrome remains poorly characterised. Despite this, clinicians' perception of this syndrome influences prescribing and it is cited to support postulated mechanisms of drug action. We recommend systematised evaluation of side-effects at earlier time points in antidepressant trials to further elucidate this clinically important syndrome.

Development of Pharmacophore Model and Asymmetric Synthesis of Novel Tetrahydrofuran Derivatives Enroute to Triple Uptake Inhibitors As Anti-Depressant Agents

10.14293/p2199-8442.1.sop-chem.pe0ika.v1 ◽

2014 ◽

Author(s):

aloke dutta ◽

Horrick Sharma ◽

Soumava Santra ◽

Joy Debnath ◽

Maarten EA Reith

Keyword(s):

Side Effects ◽

Tricyclic Antidepressants ◽

Unmet Need ◽

Antidepressant Drugs ◽

Pharmacophore Model ◽

Unipolar Depression ◽

Current Treatment ◽

Monoamine Neurotransmitters ◽

Unipolar depression, caused by an imbalance of monoamine neurotransmitters in brain, is ranked as the most prevalent of all somatic and psychiatric illness. It is estimated that about 40 % of patients remains refractory to treatment thereby limiting the use of current antidepressant drugs. Moreover, because of relapse and unwanted side effects of existing drugs there is an unmet need to discover novel agents for the treatment of this devastating mental disorder. Current treatment aims at alleviating extraneuronal concentration of serotonin (5-HT) and /or norepinephrine (NE) (Figure 1). Tricyclic antidepressants were among the first class to have been discovered but due to their nonspecific side effects they have limited use in clinics. They have been largely replaced by second-generation antidepressants including selective serotonin reuptake inhibitors (SSRI, e.g., fluoxetine, Figure 2), selective norepinephrine reuptake inhibitors (NRI, e.g. reboxetine, Figure 2), and serotonin and norepinephrine reuptake inhibitors (SNRI, venlafexine, Figure 2).

New Pharmacotherapeutic Approaches to Obsessive-Compulsive Disorder

CNS Spectrums ◽

10.1017/s1092852900027255 ◽

2009 ◽

Vol 14 (S3) ◽

pp. 13-23 ◽

Cited By ~ 7

Author(s):

Martijn Figee ◽

Damiaan Denys

Keyword(s):

Obsessive Compulsive Disorder ◽

Behavioral Therapy ◽

Response To Treatment ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Recent Developments ◽

Patients At Risk ◽

Treatment Refractory ◽

AbstractThis article summarizes results of all pharmacotherapy trials for obsessive-compulsive disorder (OCD) published from 2006 to 2008 as well as studies on markers for predicting response to treatment and neurobiological changes induced by pharmacotherapy. Results show that recent developments in the treatment of OCD have been modest and primarily involve evidence for the efficacy of escitalopram and other selective serotonin reuptake inhibitors (SSRIs); augmentation with antipsychotics in treatment-refractory patients and combination treatment with D-cycloserine and cognitive-behavioral therapy has also been effective. The efficacy of serotonin-norepinephrine reuptake inhibitors remains inconclusive. Studies on markers of clinical response have shown inconsistent results, however, duration and severity of OCD and the presence of comorbidities can often identify patients at risk for nonresponse. Lastly, successful treatment with an SSRI results in both serotonergic and dopaminergic changes, but more research is necessary in order to define the biological characteristics of responders and nonresponders.

Emotional And Behavioral Functioning

Trauma-Focused Family Therapy With Children and Their Families

The Family Journal ◽

10.1177/1066480719832503 ◽

2019 ◽

Vol 27 (2) ◽

pp. 175-182

Author(s):

Wanda Boyer

Keyword(s):

Family Therapy ◽

Family Support ◽

Behavioral Therapy ◽

Behavioral Responses ◽

Behavioral Functioning ◽

Evidence Based ◽

Family Experiences ◽

Traumatized Children ◽

Core Components ◽

Family life is considered to be a context in which children can safely learn life skills such as managing and directing their cognitive, physical, emotional, and behavioral responses to events as a way to achieve a sense of purpose and mastery in life. Traumatic events such as natural disasters, serious accidents, and violence in our homes, schools, or communities may alter an individual’s ability to manage cognitive, physical, emotional, and behavioral functioning. Trauma can significantly affect children and their families, impacting relationships, interactions, and their context. There is evidence to support the use of family therapy with children who have experienced trauma. Family support can improve interactions and relationships and can assist children in resolving trauma symptomology. Trauma-focused cognitive behavioral therapy (TF-CBT) is professionally recognized as an evidence-based intervention. There are also TF-CBT intervention derivations that have been developed to support children experiencing trauma. TF-CBT and TF-CBT intervention derivations are explored in this article including core components of evidence-based trauma-focused family therapy necessary to support traumatized children and their families. Discussion also includes the importance and evidence-based support for honoring cultural diversity and including optimism and hope into family experiences as both a preventative and interventive measure to manage trauma symptomology.

Treatment of anxiety disorders

Dialogues in Clinical Neuroscience ◽

10.31887/dcns.2017.19.2/bbandelow ◽

2017 ◽

Vol 19 (2) ◽

pp. 93-107 ◽

Cited By ~ 38

Keyword(s):

Anxiety Disorder ◽

Anxiety Disorders ◽

Burden Of Illness ◽

Behavioral Therapy ◽

Treatment Plan ◽

Treatment Options ◽

Level Of Evidence ◽

Randomized Controlled Studies ◽

Meta Analyses

Anxiety disorders (generalized anxiety disorder, panic disorder/agoraphobia, social anxiety disorder, and others) are the most prevalent psychiatric disorders, and are associated with a high burden of illness. Anxiety disorders are often underrecognized and undertreated in primary care. Treatment is indicated when a patient shows marked distress or suffers from complications resulting from the disorder. The treatment recommendations given in this article are based on guidelines, meta-analyses, and systematic reviews of randomized controlled studies. Anxiety disorders should be treated with psychological therapy, pharmacotherapy, or a combination of both. Cognitive behavioral therapy can be regarded as the psychotherapy with the highest level of evidence. First-line drugs are the selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. Benzodiazepines are not recommended for routine use. Other treatment options include pregabalin, tricyclic antidepressants, buspirone, moclobemide, and others. After remission, medications should be continued for 6 to 12 months. When developing a treatment plan, efficacy, adverse effects, interactions, costs, and the preference of the patient should be considered.

Use of Sertraline in Hemodialysis Patients

Medicina ◽

10.3390/medicina57090949 ◽

2021 ◽

Vol 57 (9) ◽

pp. 949

Author(s):

Alicja Kubanek ◽

Przemysław Paul ◽

Mateusz Przybylak ◽

Katarzyna Kanclerz ◽

Jakub Jan Rojek ◽

...

Keyword(s):

Side Effects ◽

Depressive Disorders ◽

Small Samples ◽

Placebo Control ◽

Intradialytic Hypotension ◽

Qt Interval Prolongation ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.